Laser-assisted periodontics

ABSTRACT

There is a need for a minimally invasive surgical treatment method for periodontitis for the removal of deep pockets, elimination of disease, creation of reattachment of the gingiva to the tooth surface and true regeneration of the attachment apparatus (new cementum, new periodontal ligament, and new alveolar bone) on a previously diseased root surface. The PerioLase® MVP-7™ including eGUI or another device capable of laser dosimetry, such as an original MVP-7™ type laser without the eGUI, achieves this with the LANAP protocol (laser-assisted new attachment procedure) and the LENAP protocol (laser excisional new attachment procedure).

This application is a continuation of U.S. patent application Ser. No.15/011,441, filed Jan. 29, 2016 (pending), the contents of which areincorporated herein by reference.

FIELD

The present disclosure relates to laser-assisted periodontal procedures,and more particularly relates to laser-assisted dental proceduresutilizing a dynamic user interface.

BACKGROUND

In the field of dentistry, it is common to use a laser to perform dentalprocedures such as ablation. By using a laser to perform such functionsinstead of, for example, mechanical tools, it is ordinarily possible toreduce the occurrence of complications and to improve therapeuticoutcomes.

SUMMARY

Periodontal diseases are caused by certain types of bacteria in plaqueand calculus (concrements). These bacteria create toxins which irritatethe gums, cause deep pockets, and result in a breakdown of theperiodontal tissues that support the teeth. Over time, these toxins candestroy gum tissues, and allowing the infection to progress, can resultin bone loss.

Accordingly, there is a need for a minimally invasive surgical methodfor the removal of a deep pocket, elimination of disease, reattachmentof the gingiva to the tooth surface and true regeneration of theattachment apparatus (new cementum, new periodontal ligament, and newalveolar bone) on a previously diseased root surface.

Therefore, according to one example embodiment described herein,periodontal disorders associated with teeth are treated. An averagepower for a laser is selected via a user interface on a display, alongwith a set of permissible laser parameters provided in response to theselected average power. A gingival trough or flap is created around thetooth with the laser. Infected tissue is selectively ablated ordenatured via selective photothermolysis, and a pocket is lased aroundthe affected tooth. Steps are performed to create and maintainangiogenesis. Marginal tissues are compressed against the tooth andocclusal interferences are removed.

By virtue of this arrangement, it is ordinarily possible to treatgingivitis and periodontitis in both adult and young patients whilereducing periodontal pocket defects, by establishing a newcementum-mediated periodontal ligament attachment to the root surface inthe absence of long junctional epithelium.

According to an example embodiment described herein, a laser-assistedperiodontal device includes a laser head and a controller, and thecontroller performs the steps of accepting a dosimetry amount via a userinterface on a display device, and controlling the laser head to applydosimetry in accordance with the dosimetry amount. The display devicedisplays when a predetermined portion of dosimetry has been applied.

According to another example embodiment described herein, a method forlaser treatment includes controlling a laser-assisted periodontal deviceincluding a laser head and a controller to perform steps includingaccepting a dosimetry amount via a user interface on a display device,and applying dosimetry in accordance with the dosimetry amount.

According to one aspect, a selection of an average power for a laser isreceived via a user interface on a display device, and a set ofpermissible laser parameters is provided to the display device and laserhead in response to the selected average power. The laser head iscontrolled in accordance with the laser parameters to create a gingivaltrough or flap around a tooth, ablate or denature infected tissue viaselective photothermolysis, and lase a pocket around the affected tooth.

According to another example aspect, there is an acceptance from a setof permissible laser parameters via a user interface on a displaydevice, and in a case that there is a selection to override analready-fixed parameter, the controller calculates changes to otherparameters in the set to fit a new value of the overridden parameter.

According to still another example aspect, a selection is received froma set of permissible laser parameters via a user interface on a displaydevice, and a user can fix one parameter and view permissible values ofother parameters based on the fixed parameter.

According to yet another aspect, a change to a fiber diameter on thelaser head is detected, and laser parameters are changed in accordancewith the changed fiber diameter.

According to another example aspect, a method for control of alaser-assisted periodontal device includes selecting from a set ofpermissible laser procedures via a user interface on a display device.The set of permissible procedures corresponds to a level of trainingstored in the display device for a user, and the selected procedure isperformed with the laser-assisted periodontal device.

According to yet another example aspect, data associated with thetreatment is transmitted to a data appliance, and a treatmentrecommendation is received from the data appliance based on thetransmitted data.

According to another example aspect, a running total of the energyapplied by the laser head is transmitted to a display device.

According to still another example aspect, a selection of a tooth orgroup of teeth is received via a user interface on a display device, anddata associated with operation of the laser head and the selected toothor group of teeth is stored based on the selection on the userinterface. In another aspect, the selection is of a tooth or a group ofteeth via the user interface on the display device.

According to another example aspect, a selection of a time interval, apatient, or a treatment site is received via a user interface on adisplay device, and data associated with operation of the laser head isstored based on the selection on the user interface.

According to still another example aspect, the laser head includes abendable fiber.

According to another example aspect, the laser-assisted periodontaldevice is a laser periodontal, periodontitis, gingivitis treatmentdevice for both adult and young patients.

According to one example aspect, creating a gingival trough or flaparound a tooth includes creating a circumferential and radial softtissue, gingival, or mucosal trough or flap around a tooth.

According to still another example aspect, photothermally rupturing,disassociating, separating, ablating, denaturing and vaporizing theinfected tissue includes ablating or denaturing inflamed, infected,erythematous, edematous, hyperplastic, bacteria-invaded, ulcerated,degenerated, bleeding, suppurative, or sloughing periodontal softtissue, including sulcular epithelium, junctional epithelium, andkeratinized tissue, via selective photothermolysis.

According to another example aspect, the method includes using a bluelight device with wavelength emission in the range of 400 to 520 nm,such as a diode laser, argon ion laser, light-emitting diode,superluminescent diode, or other light source to simultaneously,sequentially, or singularly irradiate the tissues for lethal effect onbacteria.

According to yet another example aspect, there is control to perform astep of circumferentially and radially irradiating surfaces of the toothand root to denature or ablate bioactive bacterial products includinglipopolysaccharide endotoxins.

According to another example aspect, the method includes diagnosing andassessing the effectiveness of treatment over time by such means asclinical examination, laboratory tests, noninvasive tools (includingoptical coherence tomography, infrared spectroscopy, acousticmicroscopy), and other techniques.

This brief summary has been provided so that the nature of thisdisclosure may be understood quickly. A more complete understanding canbe obtained by reference to the following detailed description and tothe attached drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a representative view of an environment in which aspects ofexample embodiments may be practiced.

FIG. 2 is a simplified block diagram depicting the internal architectureof the hardware shown in FIG. 1.

FIGS. 3A and 3B are a detailed block diagram of a main laser computerand a laser head assembly according to an example embodiment.

FIG. 4 is a detailed block diagram of a display control subsystem in theform of a tablet according to an example embodiment.

FIG. 5 is a representative view of hardware of a laser delivery systemaccording to an example embodiment.

FIGS. 6A to 6J are views for explaining a communication protocolaccording to an example environment.

FIG. 7 is a flow diagram for explaining a laser-assisted periodontitisprocedure according to an example embodiment.

FIGS. 8 to 67 are views for explaining an electronic graphical userinterface (eGUI) according to example embodiments.

FIG. 68 is a section of a gingival tissue prior to the administration ofa laser-assisted periodontitis procedure according to an exampleembodiment.

FIG. 69 is a section of the same gingival tissue as in FIG. 68 showingthe position of surgical tissue severing according to an exampleembodiment.

FIG. 70 is a section of the same gingival tissue as in FIG. 68 aftercompletion of a laser-assisted periodontitis procedure according to anexample embodiment.

FIG. 71 is a view for explaining a relational database for storingpatient and user data according to an example embodiment.

FIG. 72 is a view for explaining a footswitch for operating a laseraccording to an example embodiment.

FIG. 73 is a view for explaining delivery of a laser light through alaser cavity.

FIG. 74 is another view for explaining delivery of a laser light througha laser cavity.

DETAILED DESCRIPTION

I. LANAP (Laser-Assisted New Attachment Procedure)

FIG. 1 is a representative view of an environment in which aspects ofexample embodiments may be practiced. In that regard, although thisprocedure is described with respect to a specific device (PerioLase®MVP-7™ including eGUI), it should be understood that the procedure isnot limited to this device, and can be performed by other devicescapable of periodontal laser dosimetry, even devices without the eGUI,such as an original MVP-7™ type laser without the eGUI.

In particular, FIG. 1 depicts an example environment in which a dentist101 (or another clinician) inputs touch commands on a displayed eGUI ofa display control subsystem 400, which in an example embodiment hereinis a tablet 400. The commands are transmitted to a main laser computer300 and/or a laser delivery system 103 in order to control laserdelivery system 103. In the context of FIG. 1, tablet 400 is used tocontrol laser delivery system 103, which is held by dentist 101, toperform laser therapy on a patient 102. In that regard, laser deliverysystem 103 is also referred to as “laser 103” below for conciseness, oras “handpiece 103” below for differentiation from other hardwareassociated with the laser. Feedback data and other responses may betransmitted from main laser computer 300 and/or laser 103 back to tablet400, and displayed on the eGUI. These processes will be described morefully below.

In that regard, while a tablet is shown in FIG. 1, it should beunderstood that the display control subsystem may in other embodimentsbe implemented by numerous other types of devices to view the eGUI andcommunicate with main laser computer 300. More generally, a displaycontrol subsystem according to this disclosure, of which a tablet ismerely an example, includes at least a display, an input for acceptinguser input, a processor or processing independent of that of main lasercomputer 300, a communication interface to laser computer 300, andstorage capability. The display and the input are preferably combinedinto a touch-sensitive display.

For example, it should be understood that computing equipment or devicesfor implementing a display control subsystem and practicing aspects ofthe present disclosure can be implemented in a variety of embodiments,such as a laptop, mobile phone, ultra-mobile computer, portable mediaplayer, game console, personal device assistant (PDA), netbook, orset-top box, among many others. In still another example, the device forcommunicating with main laser computer 300 might be attached to orcommunicatively coupled physically in a common housing with main lasercomputer 300.

For conciseness in the description that follows, the display controlsubsystem will hereinafter be referred to as simply a “tablet”.

Main laser computer 300 contains hardware and/or software forcontrolling laser 103 via a wired or wireless interface. For example,main laser computer 300 may be a free-standing computing deviceincluding a hard disk and one or more processors dedicated to control oflaser 103.

Laser 103 is a handheld laser for performing laser therapy includinglaser dentistry (e.g., ablation of bacteria in gum tissue). For example,laser 103 might correspond to a “PerioLase® MVP-7™”, manufactured byMillennium Dental Technologies, Inc. In that regard, the PerioLase®MVP-7™ is a 6-Watt FR (Free Running) Nd:YAG (Neodymium:Yttrium AluminumGarnet) laser with features necessary to perform soft tissue procedures,and includes operator-selectable pulse durations from, e.g., 100 to 650microseconds (μsec) to allow optimum ablation and hemostasis.

Hardware Elements

FIG. 2 is a simplified block diagram depicting the internal architectureof the hardware shown in FIG. 1.

In particular, as shown in FIG. 2, tablet 400 includes centralprocessing unit (CPU) 201, memory 202, I/O unit 203 and network unit204.

Central Processing Unit (CPU) 201 is a computer processor such as asingle core or multi-core central processing unit or micro-processingunit (MPU), which is constructed to realize the functionality describedbelow. CPU 201 might comprise multiple computer processors which areconstructed to work together to realize such functionality. CPU 201executes a computer-executable program (sometimes referred to ascomputer-executable instructions or computer-executable code) to performsome or all of the above-described functions.

Memory 202 may be any of a wide variety of tangible storage deviceswhich are constructed to retrievably store data, including, for example,any of a flexible disk (floppy disk), a hard disk, an optical disk, amagneto-optical disk, a compact disc (CD), a digital versatile disc(DVD), micro-drive, a read-only memory (ROM), random-access memory(RAM), erasable programmable read-only memory (EPROM), electronicallyerasable programmable read-only memory (EEPROM), dynamic random-accessmemory (DRAM), video RAM (VRAM), a magnetic tape or card, optical card,nanosystem, molecular memory integrated circuit, redundant array ofindependent disks (RAID), a nonvolatile memory card, a flash memorydevice, a storage of distributed computing systems and the like. Memory202 is constructed to store computer-readable information, such ascomputer-executable process steps or a computer-executable program forcausing CPU 201 to communicate inputs on tablet 400 to main lasercomputer 300 and/or laser 103 and to receive and display data, asdescribed more fully below.

I/O unit 203 includes hardware and/or software for interfacing tablet400 with other devices or a user, such as receiving input andtransmitting or displaying output. In the context of tablet 400, I/Ounit 203 might include hardware and software for, e.g., recognizing atouch input on the face of tablet 400 (or other input via hardware ontablet 400 such as a pressable button or voice input), and fordisplaying output to a user via a display on tablet 400. For example,I/O unit 203 might control display of an eGUI, as described more fullybelow with respect to FIG. 3.

Network unit 204 includes hardware and/or software for communicatingwith other devices across a wired or wireless network (not shown). Asshown in FIG. 2, network unit 204 communicates with correspondingnetwork unit 273 at laser 103, and network unit 253 at main lasercomputer 300. For example, network unit 204 may communicate controlcommands to network unit 253 at main laser computer 300, and may receivefeedback from network unit 273 at laser 103. Of course, communication isnot limited to the devices shown in FIG. 2, and network unit 204 may beused to transmit various data across various networks. In that regard,the implementation, scale and hardware of the network may vary accordingto different embodiments. Thus, for example, the network could be theInternet, a Local Area Network (LAN), Wide Area Network (WAN),Metropolitan Area Network (MAN), or Personal Area Network (PAN), amongothers. The network can be wired or wireless, and can be implemented,for example, as an Optical fiber, Ethernet, or Wireless LAN network. Inaddition, the network topology may vary.

As shown in FIG. 2, main laser computer 300 includes CPU 251, memory252, network unit 253, and I/O unit 254, and laser 103 includes CPU 271,memory 272, and network unit 273. In that regard, the general nature ofthese elements corresponds to the description above of similar elementsin tablet 400, and for purposes of conciseness will not be repeatedagain. Nevertheless, it should be understood that each element (e.g.,memory, CPU) would be tailored to the corresponding device. Thus, forexample, CPU 251 in main laser computer 300 might execute programs toimplement functionality for receiving input from tablet 400 andtransmitting commands to laser 103, whereas CPU 271 in laser 103 mightexecute programs to implement functionality for emitting a laser beamand recording feedback.

Laser 103 also includes laser 274, which is hardware for performinglaser therapy as described above.

FIG. 3 is a detailed block diagram of a main laser computer and a laserhead assembly according to an example embodiment.

In particular, as shown in FIG. 3, a main laser computer 300 includes abus 315, a Galaxy Interface Box™ (GIB) 301, a processor 302, RAM 303, anelectronically alterable read-only memory (EAROM) or other memoryfunctioning as a storage 304, an interlock/key switch 305, a stop switch306, a power supply 307, a distributor bus 308, a high energy storage309, an insulated-gate bipolar transistor (IGBT) switch 310, adigital/analog (D/A) switchboard 311, an analog/digital (A/D) interfaceboard 312, a Molectron (calibration target) 313 and a footswitch 314.Meanwhile, a laser head assembly includes laser head 315, feedbacksensor 316, smart connector 317, laser delivery system 103, flow sensor318, thermistor temperature sensor 319, heat exchanger 320, and pump321.

As a general matter, main laser computer 300 directs energy pulseshaving energy into laser delivery system 103. Thus, electrical energy(electrons) is converted into laser energy (photons). The laser pulse(and therefore energy supplied) may vary based on a pulse duration (inμs), an amount of instantaneous energy (in mJ), or a pulse repetitionrate (in Hz), each independently selectable under software control ofmain laser computer 300, as described more fully below. The control tovary the pulse is important from a therapeutic perspective, as differentdurations, energies and the like may be beneficial under differentcircumstances or during different treatments. Under control of the mainlaser computer 300, IGBT 310 switches capacitance and inductance inorder to store pulses. As far as the laser head, the use of an Nd:YAGlaser is acceptable. Thus, an Nd:YAG crystal (not shown) sends out aseries of pulses, directed through lenses, to a bendable optical fiberin laser delivery system 103. Fibers with different diameters can beused to, for example, specialize for certain procedures, althoughparameters must be recalculated to ensure that they are withinacceptable limits after a fiber is switched. In order to cause the mainlaser computer 300 to create pulses, it is directed by a user interfaceon tablet 400, as described in more detail below.

Standby Mode

In standby mode, the controller sets the mains relay, capacitor boardrelay, simmer circuitry, and an aiming beam off. The user can selectparameters at the control panel, but the footswitch will not activatethe laser.

Ready Mode

When the ready button is pressed, and if no faults are present,processor 302 closes an on-board relay which powers the pump and themains relay. The capacitor relay is still open, so the capacitor is notcharged. The aiming beam is turned on after two seconds.

Firing Mode

When the footswitch is pressed in ready mode, the system enters firingmode. Processor 302 closes a second on-board relay, which provides 12Vto the simmer circuitry and the capacitor relay control. Within 250 ms,the capacitor has charged and the lamp is lit. Processor 302 then fireslaser pulses at the parameters set on the control panel. Processor 302stores the lamp current required for each energy level in non-volatilememory, and uses this current again when that energy is next selected.During firing, the current is continually adjusted to match the measuredlaser energy to the selected energy. A calibration factor, set duringcalibration procedures, provides the conversion. When the footswitch isreleased, the laser stops firing. The lamp remains lit for a shortperiod, however, to allow rapid tapping of the footswitch withoutfrequent lamp starts. After a period of inactivity, the system returnsto standby.

In one example, when the 12V power supply comes on, processor 302 powersup and performs system tests, does a display lamp test for 2 seconds,displays the software version number, and enters the standby mode.

Thus, main laser computer 300 produces pulsed Nd:YAG laser output from afiber-optic delivery system. Laser parameters are set by the user on atouch screen 408 (see FIG. 4) on tablet 400, and output is actuated byfootswitch 314.

Processor 302 is a computer processor such as a single core ormulti-core central processing unit or micro-processing unit (MPU), whichis constructed to realize the functionality described below. Processor302 might comprise multiple computer processors which are constructed towork together to realize such functionality. Processor 302 executes acomputer-executable program (sometimes referred to ascomputer-executable instructions or computer-executable code) to performsome or all of the above-described functions. Processor 302 manages thegeneral operation of main laser computer 300, including controls anddisplays, the cooling system, the laser electronics, the laser energyfeedback, interlocks and sensors, and retrieving or saving data. In thatregard, processor 302 executes data stored in a memory, e.g., RAM 303,in order to perform required functions. In some cases, processor 302might comprise a single core or multi-core central processing unit (CPU)or micro-processing unit (MPU). In one example, processor 302 comprisesa BL4S210 single-board computer.

RAM 303 is random-access memory which allows data items to be read andwritten in approximately the same amount of time, regardless of theorder in which data items are accessed. In addition to serving astemporary storage and working space for the operating system andapplications, RAM is used in numerous other ways, which for purposes ofconciseness are not described here in further detail.

In one example, communication from the tablet is via a USB interface,whereas main laser computer 300 uses an RS485 interface. To that end,GIB 301 is a Galaxy Interface Box™ for converting between USB and RS485.In particular, GIB 301 may include a USB hub so that tablet 400 canbecome a client and charge, i.e., a “kiosk mode” in which the hub allowsfast data while also charging. In one example, GIB 301 includes a 9600baud serial interface and is bidirectional, and charges itself from aregulated power supply via distribution bus 308.

In one brief example, upon pressure of a footswitch 314, power isdirected from A/D interface board 312 to D/A switchboard 311 to IGBTswitch 310 to high energy storage 309 to laser head 315. Thus, D/Aswitchboard 311 powers IGBT switch 310.

Bus 315 is a communication system that transfers data between componentsinside main laser computer 300. In that regard, the internal structureof bus 315 may vary.

In one example, D/A switchboard 311 provides lamp start and simmerfunctions, and converts low voltage controller signals to isolated IGBTsignals. To start the lamp, 12V is applied to the input of a DC-to-DCconverter, which applies a voltage (e.g., 1100 V) across the lamp. Atthe same time, 300 V pulses are applied to the trigger transformerprimary, generating 15 kV pulses to start the lamp. Once the lamp islit, simmer current is drawn from the pulse capacitor, and is ballastedby a bank of external simmer resistors. The lamp pulse current is set bya serial signal from processor 302, which controls the output of aserial digital-to-analog converter (DAC). The actual lamp current ismonitored by a shunt resistor, and compared to the DAC output. Switchingcircuits modulate the IGBT 310 to set the current. The pulse width isset by a gating signal from the processor 302, which does not passthrough the interface board.

In one example embodiment, laser head assembly 350 contains the pumpchamber with flashlamp, Nd:YAG rod, and trigger transformer; lasercavity optics, an energy monitor, a fiber lens cell, and a diode laseraiming beam. All are supported by an aluminum and graphite/epoxyresonator structure. The flashlamp output is absorbed by the Nd ions inthe YAG rod, and provides the gain which supports laser oscillation. Thelaser pulse shape closely matches the lamp electrical pulse, except forsome smoothing caused by the fluorescent lifetime of the gain medium.The energy monitor contains a beam sampler, which splits off 4% of theoutput beam. This sampled beam is spatially integrated by a pair of opaldiffusers, then converted to electrical current by a reverse-biasedgermanium PIN photodiode. Circuitry on the energy monitor board convertsthis current into a stream of digital pulses, which are counted by thecontroller. After subtraction of a background count, the total number ofpulses is proportional to the laser energy.

High energy storage 309 is a high-energy power supply, i.e., is astorage device configured to store a relatively large amount of energy,and is switched by IGBT switch 310. The amount of energy supplied may bedependent on a switchable mode and/or input via independently selectableparameters, e.g., duration (in μs), an amount of instantaneous energy(in mJ), or a pulse repetition rate (in Hz). The switch between themodes/parameters above (e.g., between different modes corresponding todifferent amounts of energy or between different laser parameters suchas duration and instantaneous energy) may be digital. In one example,energy for the laser flashlamp is stored in a pulse capacitor. Thecapacitor is charged to 600 V through a step-up toroidal transformerpowered from the mains relay, and a bridge rectifier on the capacitorboard. The capacitor board also contains a high voltage solid staterelay, which controls the charge timing and regulates the voltage.

Molectron 313 is a hardware power meter which acts as a calibrationtarget. In particular, a user can aim the laser at the window ofMolectron 313, and see if the laser is performing as requested. Forexample, Molectron 313 measures the output power, and verifies whetherthe average power requested or expected from a set of parameters is whatis actually being output by the laser. To that end, Molectron 313 isconnected to A/D interface board 312, which routes the measuredpower/information back to the main laser computer 300, specificallyprocessor 302. Firmware in Molectron 313 may support such a calibrationmode and provide feedback to the user via an eGUI on the tablet.Calibration in Molectron 313 works in tandem with feedback sensor 316 inlaser head assembly 350, which detects the flow of energy through thelaser head. In one example, ordered pairs/sets of parameters may bestored as calibration factors/best fits for an input value, e.g.,average power.

A/D interface board 312 collects and converts (if necessary) variousanalog values, and transmits information corresponding thereto toprocessor 302. For example, as shown in FIG. 3, A/D interface boardcollects data from Molectron 313, flow sensor 318, thermistortemperature sensor 319, smart connector 317, interlock/key switch 305,and footswitch 314. Accordingly, A/D interface board 312 measures, e.g.,power, cooling and other housekeeping data, and processor 302 caninquire with A/D interface board 312 (or A/D interface board 312 maypush information thereto) in order to verify that the laser isperforming within specifications.

Thus, A/D interface board 312 monitors and receives analog or digitalsignals from various parts of the main laser computer 300 and laser headassembly 350, converts the information to digital data, and forwards thedigital data on for processing (e.g., to processor 302). In one exampleembodiment, the only digital communication between the system and A/Dinterface board 312 is via the D/A switchboard 311. Put another way, A/Dinterface board 312 is responsible for taking in analog inputs andconverting them to digital information, but the D/A switchboard 311 actsas a messenger to forward that information from A/D interface board 312to other components in main laser computer 300. Accordingly, in such anexample embodiment, A/D interface board 312 does not directlycommunicate with other components such as processor 302.

Footswitch 314 is a physical pedal or other foot-actuated hardware whichsends a signal upon being pressed, such as a signal indicating to firethe laser. Of course, the physical element for activating the laser isnot limited to a footswitch, and other hardware elements and control arepossible. Footswitch 314 is connected to A/D interface board 312 inorder to transmit signals to the main laser computer 300.

Interlock key switch 305 is the physical connection to an external mainpower supply (e.g., via a plug), and is connected to stop switch 306.Together, these elements perform line filtering, as well as acting as atwo-step fail-safe for providing or cutting power, and are connected topower supply 307.

Power supply 307 is a regulated power supply, and acts as an embeddedcircuit to input unregulated energy into a stable power supply, e.g., astable voltage or current within set limits. In one example, AC mainsenters at the back panel, and is fused and filtered. The front panel keyswitch controls AC input to the 12V power supply, which powers thecontroller and all low voltage components.

Distribution bus 308 fans power out to elements of main laser computer300 as needed. To that end, distribution bus includes a 5V output and a12V output, among others as necessary. For example, parallel circuitsallow distribution bus 308 to transmit power to high energy storage 309.

IGBT switch (“IGBT”) 310 is a solid-state switch which acts as anamplifier of signals from D/A switchboard 311. In one example, IGBT 310is essentially a large transistor, acting as an amplifier. D/Aswitchboard 311 acts together with the IGBT to control high energystorage 309 to drive the laser head assembly 350. The laser may need to“simmer” prior to usage, in which a certain lower amount of power isused to get the laser ready for firing. In one example, the shape of thecurrent pulse is controlled by the IGBT 310 and a smoothing inductor.The IGBT 310 allows control of both the amplitude and width of thepulse.

EAROM 304 for main laser computer 300 stores firmware programs forcontrolling the operation of main laser computer 300, as well as datacorresponding thereto. In one example embodiment, a softwarearchitecture stored in EAROM 304 includes a real-time operating system(RTOS) based on dynamic C programming (e.g., version 9.62), a monitoringmodule, an initialization/startup module (such as for controlling a“simmer” mode for warming up the laser), a firing module for controllingfiring of the laser, and a communication module for performing, e.g.,RS485 communication to D/A switchboard 311 (for internal communications)and to GIB 301 (for external communications). EAROM 304 also storescalibration factors and calibration values in a persistent manner, andcan return appropriate signals for the IGBT 310 and A/D interface board312 in accordance with requested signal parameters. EAROM 304 may alsostore permissible values or a “permissible therapeutic window” whichincludes combinations of laser parameter values. Examples can be seen inU.S. Publication No. 2003/0108078. EAROM 304 may also store otherhousekeeping information, such as a serial number of the laser.

In the laser head assembly 350, a cooling system includes flow sensor318, thermistor temperature sensor 319, and heat exchanger 320. Coolingincludes both primary and secondary systems. The primary system mayinclude distilled water conduction (flow) through the laser head 315,and a secondary system may use forced convection (a fan). Flow detectionsensor 318 issues an analog signal indicating whether the amount of flowthrough the laser head is acceptable or not, and interfaces to A/Dinterface board 312. Heat exchanger 320 is a forced convection heatexchange, e.g., a small control loop for the fan which monitorstemperature through thermistor temperature sensor 319, transfers heat asnecessary, and reports temperature to A/D interface board 312.

In one example, the cooling system consists of a 12V brushless DC pump,a heat exchanger, a 12V brushless DC temperature-sensing fan, a flowswitch, a thermistor sensor, and connecting corrugated Teflon tubing.The coolant is approximately 400 ml of de-ionized or distilled water.The fan is powered directly from the 12V supply, but includestemperature sensing circuits to monitor the coolant temperature. If thecoolant reaches 40° C., the fan speed increases gradually. Thecontroller board contains a relay which drives the pump 321. Thecontroller also monitors the coolant temperature via the thermistor.

Smart connector 317 is connected to laser head 315, laser deliverysystem 103 and A/D interface board 312, and acts to transfer informationsuch as analog feedback to A/D interface board 312 (which is thenconverted to digital information for processor 302), as well as todetect certain conditions on its own. For example, smart connector 317can detect the fiber diameter in laser delivery system 103, and thenrelay this information to main laser computer 300 or tablet 400. Asmentioned above, parameters must be recalculated to ensure that they arewithin acceptable limits after a fiber is switched. Error codes may betransmitted from smart connector in accordance with a mismatch betweenfiber and parameters, or in accordance with any other conditions thatare out of specification. A non-limiting example of error codes isdescribed below with respect to FIG. 15.

In one aspect, analog feedback from smart connector 317 to A/D interfaceboard 312 may be sent via near-field communication (NFC),radio-frequency identification (RFID) transmissions, and the like. Forexample, analog feedback may be sent to confirm the laser fiber diameterif the user has changed the fiber, but wants to keep the same powerdensity, as well as to confirm that the laser parameters meet safetyrequirements.

Feedback sensor 316 detects the flow of energy through laser head 315,and tells processor 302 the status of the laser, including parameterssuch as, e.g., average power. Feedback sensor may also be configured totransmit an error message to stop the laser, as a fail-safe for when thelaser appears to be operating incorrectly.

FIG. 4 is a detailed block diagram of a tablet according to an exampleembodiment.

As shown in FIG. 4, tablet 400 includes bus 413, Bluetooth unit 401connecting to pdf element 425, printer 426 and data appliance 427, WiFiunit 402, near-field communication (NFC) unit 403, camera 404,nonparametric statistical process control (NSPC) unit 405, speaker 406,microphone 407, touch screen 408, USB 409, RAM 410, non-volatile memory411 and processor 412.

Generally, tablet 400 may run on a Linux/Unix-based Operating System(OS). For example, tablet 400 may be an Android™ tablet running OSversion 4.2.2. Of course, numerous other variations on hardware andsoftware are possible.

According to one embodiment, default safeguards are modified oreliminated to allow for direct calls to the OS (e.g., from main lasercomputer 300), thereby allowing the tablet 400 to be used as aneffective control system. In another example, variants of Linux allowingsuch calls may be used.

The main functionality of tablet 400 covers a variety of aspects. In oneaspect, functionality is computational, such as receiving calls to arelational database in non-volatile memory 411, e.g., recording data fora particular patient or user, including a location of the mouth andobservations related thereto, as well as computing a new set of laserparameters in accordance with a user request on touch screen 408 tochange a different parameter, and forwarding such parameters to mainlaser computer 300 for verification. In another aspect, tablet 400functions as a communication medium between a user and main lasercomputer 300, and performs functions such as transmitting data to andfrom main laser computer 300, including commands, feedback, error codes,and input laser parameters.

Insofar as the eGUI is concerned, it should be understood that variousdisplay and control arrangements are possible. In addition, numerousaspects of different eGUI screens and controls will be described morefully below with respect to FIGS. 8 to 67.

Nevertheless, for purposes of clarity, an example embodiment will bedescribed which includes four main “control surfaces” on the displayedeGUI which can be switched between using, e.g., a “swipe” on touchscreen 408.

First, a “home screen” provides main command and control functionality,including control of patient management and of main functionality of thelaser. For example, the home screen allows a user to view informationconcerning a patient selected from a patient management surface(described below), to select and vary clinical laser parameters, toselect a quadrant of the mouth, tooth or tooth group for treatment, andthe like. In addition, the home screen allows for monitoring and controlof the laser itself. For example, the home screen may display “standby”,“ready” or “FIRE” as the status of the laser, in accordance with theoperation of the laser in response to a press of footswitch 314.

In one example aspect, when the footswitch 314 is actuated, informationincluding the patient, tooth, etc. selected or displayed on the tableteGUI is saved to non-volatile memory 411 in the tablet, along with arunning total of energy, pulses, parameters, dosimetry and the like forthe period in which the footswitch is held, and an editable name for thecurrent treatment period, e.g., “First Pass On Bicuspid”.

In one example embodiment, the recorded data may be used to recommendnew laser parameters. For example, treatment feedback may be fed to adata apparatus, and may be used to calculate new recommended laserparameters for the current patient and procedure.

In another example, a manual power measurement mode may allow for laserdata to be saved without being tied to a patient. For example, if athreshold energy is reached, recording may stop and measurement of powermay begin, even if the user is not currently using Molectron 313.

Second, a “patient management screen” allows for access and display ofinformation from a database of up to thousands of patients or more, aswell as providing manipulation of such information, such as adding,deleting, or selecting a patient.

In one example, information about a patient is displayed (e.g., name, IDnumber, dental history), along with, e.g., dental records or linksthereto. Thus, the patient management screen can integrate electronicdental records, as required in some instances by Federal law. Forexample, the patient management screen can provide digital reports in aHIPAA-compliant manner, which can be readily integrated with patientdata files. In that regard, additional security measures may preventunauthorized persons from offloading the information gathered.

Third, a “procedures control surface” allows for selection and controlof laser procedures, and may include, for example, a table with presetlaser parameters (e.g., in sets or “triplets” comprising threeparameters) for sample procedures, as shown more fully below.

In one aspect, the procedures control surface is used to providetraining procedures for users such as a dentist and clinician. Forexample, a user may log into the home screen, after which the eGUIdepicts information about the currently logged-in dentist or other user,such as name, ID number, and, for example, an indication of training orcertification and what corresponding service modes are available. Inthat regard, the term “dentist” is used here for purposes ofconciseness, but it should be understood that “clinician” and the likecould also be used. In addition, service modes may allow, e.g.,operation of the laser at fixed current and pulse width, whilemonitoring the internal energy monitor, and changing a calibrationfactor, to match the laser output to an external power meter testing ofthe capacitor charge, whereas another service mode might allow testingof lamp start and simmer circuits, setting of the initial lamp current,and display of the coolant temperature. Yet another service mode mightrestore default parameters, display energy monitor counts, or the like.

The procedures control surface may provide advanced features andcapabilities for control of laser as user training and certificationpermit. Thus, in one example, procedures control surface allows fortraining, in which additional features or options are made availableonly after the user has completed a training course. For example, whilea control box may be shown for selection of one feature set, anotherfeature set may be displayed with a lock icon indicating that thefeature set is currently unavailable (e.g., because of insufficienttraining). The procedures control surface may also display iconsindicating levels of training which have been completed.

In one embodiment, a database (e.g., SQL) or table stores acorrespondence between each user and authorized procedures andcorresponding laser parameters. For example, a value of 0, 1, or 2 maybe assigned for a user for certain procedures, with 0 indicating thatthe user can see the procedure but not use it, a 1 indicating that theuser has access to that procedure/parameters and can use them, and a 2indicating that the user can see, use, and even overwrite the parametersfor a given procedure. In that regard, the corresponding eGUI may bemore simple than the stored table values. In addition, controls such asoverriding parameters for a procedure may require transfer to the homescreen (with or without a corresponding warning), since the home screengoverns more basic controls.

In a real-world example, controls on the procedures control surface canbe integrated with a training program from, e.g., the Institute forAdvanced Laser Dentistry (IALD). The IALD is an American DentalAssociation Continuing Education Recognition Program (ADA CERP®)Recognized Provider that administers a CE training program that includesa standard proficiency course along with four days of hands-on,live-patient clinical instruction to ensure success by thepractitioners.

Thus, features in the procedures control surface can be synthesized fromimpactful portions of the IALD training continuum. Accordingly, theprocedures control surface can be designed to reflect the training,rather than altering training to fit a device design.

In one example, the procedures control surface is configured so that theclinician who is in the midst of completing his/her training will haveaccess to only the features of the laser for the LANAP® and LAPIP™protocols that they have learned at that point in training, commensuratewith their level of clinical proficiency as certified by the IALD. Inaddition, these clinicians will also learn additional value-addedprocedures (VAPs™) based on their level of training. In one example, aunique password is issued to each dentist at the completion of eachlevel of training, which reveals the features that are appropriate. Forexample, in the context of IALD certifications, clinicians might receivenew passwords after they complete Laser BootCamp®, after they completeEvolution 4™ and after they complete Evolution 5™. With such control ofaccess to laser control, the IALD can give LANAP®-clinicians-in-trainingthe access to only what they have learned. This will increase safety ofLANAP® patients, and will guide the clinicians toward techniques andtherapeutic settings, encouraging them to use only the techniques thatthey have mastered up to that point.

In addition to the above, the procedures screen may also display a lightdose chart, showing an amount of laser dosimetry over time, as well as aline indicating the maximum dosage allowed for that tissue/procedure.For example, the procedures screen may, using information from thepatient records, determine a disease being treated and a dosageadministered thus far, and display a “max” line on a graph, with adosage line which increases in real time toward the maximum as furtherlaser dosage is applied.

An “Admin” maintenance/settings screen may allow for generalhousekeeping and maintenance control, such as setting a time zone ordate, adjusting display settings such as selecting between a simplifiedand more complex display, control icons, and the like.

In one example, the tablet eGUI may show which combinations of laserparameters (e.g., duration (in μs), an amount of instantaneous energy(in mJ), or a pulse repetition rate (in Hz) as discussed above) areallowed and/or within safe limits. Put another way, the tablet eGUI mayuse rules to keep parameters within specified therapeutic “windows”, andprevent control of parameter values outside such windows. For example, auser or administrator might be able to unlock a locked parameter (e.g.,instantaneous energy), but the system may force the other two parametersto safe boundaries in accordance with the newly selected instantaneousenergy, and display information as such to the user.

Such control may be enforced from main laser computer 300, and thentransmitted to the tablet 400 to display on the eGUI. In anotherexample, having received a recalculation of a locked (or unlocked)parameter, tablet 400 may perform a recalculation of other parameters atits end, and then transmit the new parameters to main laser computer 300for validation or refusal (e.g., as indicated by an error message,grayed-out parameter values, etc.). Generally, main laser computer 300will not send an illogical choice of parameters to the laser, whereasthe tablet will not allow selection of an illogical combination at theuser end on the display. The tablet 400 may store default combinationsof parameters.

Turning to the hardware of tablet 400, in one example, RAM 410 israndom-access memory which allows data items to be read and written inapproximately the same amount of time, regardless of the order in whichdata items are accessed. In addition to serving as temporary storage andworking space for the operating system and applications, RAM is used innumerous other ways, which for purposes of conciseness are not describedhere in further detail.

Bluetooth 401, WiFi 402 and NFC 403 variously act as wireless networkunits for wirelessly interfacing with main laser computer 300 or otherdevices, whereas USB 409 acts as a physical connection to other devices.Bluetooth 401 is hardware/software for exchanging data over shortdistances (using short-wavelength UHF radio waves in the Industrial,Scientific and Medical (ISM) bands from 2.4 to 2.485 GHz) from fixed andmobile devices, WiFi 402 is hardware/software for local area wirelesscommunications, and NFC 403 is hardware/software for NFC-protocol-basedradio communication with nearby devices or elements.

In some examples, these units interface with a data appliance 427, shownin FIG. 4. Data appliance 427 is, e.g., a physically and electronicallysecure data server with hardwired digital electronic interfaces andwireless digital electronic interfaces. Data appliance 427 may act as amore secure storage for data such as patient records, including HIPAAreports. In some cases, the tablet 400 may first transmit such data todata appliance 427 using Bluetooth, which then offloads the data toanother computer such as a PC (not shown). Such a transfer can also betwo-way, in that information such as recommendations can be transmittedback to the tablet, with treatment progress and recommendationsre-synchronized again with the PC after new treatment, etc. In somecases, WiFi may be used to transmit data from the tablet if, under thecircumstances, it is more secure (or HIPAA compliant).

Camera 404 is an optical instrument for recording images, which may bestored locally, transmitted to another location, or both. The images maybe individual still photographs or sequences of images constitutingvideos or movies.

NSPC 405 is hardware/software for monitoring and controlling processesin tablet 400 to ensure that it operates at or near its full potential.Speaker 406 is an electromechanical element which produces sound.Microphone (“Mic”) 407 is an acoustic-to-electric transducer or sensorthat converts sound into an electrical signal.

Touch screen 408 is a hardware/software input device normally layered onthe top of an electronic visual display, by which user can give input orcontrol the information processing system through simple or multi-touchgestures by touching the screen with a special stylus/pen and/or one ormore fingers. As described above, touch screen 408 displays severaleGUIs and controls, along with various data.

USB 409 is a connector for communicating via the Universal Serial Busprotocol, and in particular, is used to communicate from tablet 400 tomain laser computer 300 via GIB 301.

Non-volatile memory 411 is computer memory that can retrieve storedinformation even after having been power-cycled. Examples ofnon-volatile memory include read-only memory, flash memory,ferroelectric RAM (F-RAM), most types of magnetic computer storagedevices (e.g. hard disks, floppy disks, and magnetic tape), and opticaldiscs.

Processor 412 is a computer processor such as a single core ormulti-core central processing unit or micro-processing unit (MPU), whichis constructed to realize the functionality described below. CPU 201might comprise multiple computer processors which are constructed towork together to realize such functionality. CPU 201 executes acomputer-executable program (sometimes referred to ascomputer-executable instructions or computer-executable code) to performsome or all of the above-described functions.

FIG. 5 is a view for explaining a laser delivery system 103 with abendable cannula 502 containing a bendable laser fiber according to anexample embodiment. The laser delivery system 103 is held by the dentist(or clinician, etc.), and is the physical implement used to administerlaser energy to a patient through the bendable cannula 502. As shown inFIG. 5, the bendable cannula 502 can bend up to 90°, which allows forbetter access to parts of the mouth which might otherwise be obscured ordifficult to reach. Thus, according to one example embodiment, a laserdelivery angle may be adjusted.

Communications Protocol

FIG. 6A and FIG. 6B are views for explaining the protocol fortransferring data between tablet 400 and main laser computer 300 via,e.g., GIB 301. Of course, it should be understood that this arrangementis merely an example, and other arrangements and data combinations arepossible.

In one example, tablet 400 issues command packets over the USB/RS485communications link via GIB 301, and expects an appropriate reply packetto be returned by main laser computer 300 as slave device. Allcommunications are initiated by the GIB 301 and GIB 301 performs atiming check to make sure the tablet 400 is periodically communicating.In the event that the tablet 400 stops communicating with main lasercomputer 300 for a predetermined period of time, e.g. a couple ofseconds, main laser computer 300 will drop out of any active mode andreturn to the standby mode. This prevents the system from being operatedwithout tablet 400 attached and communicating. In this context thetablet 400 is essentially the user interface controlled by the operatorand the main laser computer 300, and specifically processor 302 is theembedded controller that handles the laser power control and theoperator footswitch.

The communications packets include a 16-bit cyclic redundancy check(CRC) to prevent badly formed packets or packets containing bit errorsfrom being used to set laser operating modes and operating powersetpoints. In one example, upon start-up, tablet 400 sets a status mode,packet position 5 to 14, requesting a long word response from the mainlaser computer 300 to determine a firmware revision. Tablet 400communicates with main laser computer 300 periodically. In one example,the period is 4 Hz.

Communication between tablet 400 and main laser computer 300 (alsoreferred to as PerioLase® Main Controller or PerioLase® Main Computer)comprises serial communication, and is converted between USB and RS485using GIB 301. As shown in FIG. 6A, a communication 601 from theprocessor in tablet 400 to the main laser computer 300 may comprise apacket with 13 bytes: a one-byte address (which can, e.g., always be 0or 0x00 for a master in a master-slave communication), a one-byte packetlength (e.g., the packet length to follow, which might always be 11, or0x0B), a one-byte pulse duration (e.g., an index into pulse widthselections such as “0-6”, or 0x00-0x06), a one-byte energy inmillijoules such as the energy expended during a footswitch period(e.g., an index into energy selections 0-25 or 0x00-0x19), a one-bytefrequency in Hz (e.g., an index into pulse rate selections such as“0-10”, or 0x00-0x0A), a mode (e.g., standby/ready/service), otherone-byte parameters (generically referred to here as “Parameter 1” and“Parameter 2”), a one-byte aiming beam intensity (e.g., an intensitysetting value from 0-5), a one-byte tube start current (e.g., an startcurrent value from 10-80, and a default value of 15), a one-bytecalibration factor value (e.g., 0-99) used to scale and display averagepower, and two cyclic redundancy check (CRC) bytes. Such a packet mightbe sent, for example, every time the laser mode changes from “standby”to “ready”, i.e., when the user is ready to take action.

A short response 602 from main laser computer 300 to tablet 400 might be17 bytes: a one-byte address (which can, e.g., always be 1 or 0x01 for aslave in the master-slave communication), a one-byte packet length tofollow (e.g., always 17 or 0x11 for this reply structure), a one-bytepulse width (e.g., an index into pulse width selections such as “0-6”,or 0x00-0x06), a one-byte energy in millijoules (e.g., an index intoenergy selections 0-25 or 0x00-0x19), a one-byte frequency in Hz (e.g.,an index into pulse rate selections such as “0-10”, or 0x00-0x0A), aone-byte status code for an operating mode (e.g., an operating mode suchas 0-6, 10, 11 or 15, described below), a one-byte error mode (or errormode code, discussed above, which may be, e.g., an error code such as 15when in an error mode), two bytes of Molectron reading outputs (e.g.,two values, in analog-to-digital converter (ADC) counts 0-10000, 0-10volts), two bytes of joule count energy meter reading values (e.g., twoenergy monitor per pulse average values in mJ), two calibration factorbytes for energy meter calibration factors (two values, e.g., from0-99), four bytes of total energy delivered (e.g., the total mJdelivered at all pulse widths), and two CRC bytes.

In one example, the Molectron reading contains a temperature sensorreading in Service Mode 2. Moreover, in one example, an energy monitorvalue incorporates the calibration factor to convert energy meter pulsesto mJ, and readings greater than 2*a mJ setpoint result in an errorcode. For example, the calibration factor value 0-99 gets an offset of50 added to it to produce 50-149, and the energy monitorvalue=pulses*200/Calibration Factor (50-149). In still another example,the total energy delivered values get cleared in the status mode after areply.

A longer response 603 from main laser computer 300 to tablet 400 mightinclude additional bytes indicating firmware (major and minor) and afirmware build and values representing an energy array which indicatesthe total running energy (joules) so far during one footswitch press.These response packets might be sent at start-up, or in case of an errorcode, or at another timing.

For example, as shown in FIG. 6C, response 603 might include a one-byteaddress (e.g., always 1 for Slave (0x01)), a one-byte packet length tofollow (e.g., always 34 (0x22) for this reply structure), a one-bytestatus/operating mode (e.g., which might always be a value such as 14for this reply structure), a one-byte firmware major value indicatingthe firmware version major number and a one-byte firmware minor valueindicating the firmware version minor number, a one-byte firmware buildvalue indicating the firmware version build number, and two CRC bytes.Moreover, as shown in FIG. 6C, response 603 might include 14 bytes oftotal energy values delivered at various pulse widths. These values maybe cleared after a reply.

FIG. 6D shows example pulse duration selections which may range from,for example, 100 μsec to 650 μsec, along with corresponding indexes.FIG. 6E depicts example modes (e.g. those included in short response602) which may include standby, ready, laser on, and the like. FIG. 6Fdepicts example indexes and corresponding energy selections (in mJ).FIGS. 6G and 6H depict example parameter 1 and parameter 2 values,respectively, and may store, for example, calibration currents orcalibration factors in a service mode. FIG. 6I depicts example errorcode values, and FIG. 6J depicts example pulse rate selections andcorresponding indexes.

It should be understood that the foregoing are merely examples of dataand data formatting according to the communication protocol, and thatvarious other data elements and arrangements are possible.

Periodontitis Procedure

FIG. 7 is a flow diagram for explaining a LANAP® Procedure according toan example embodiment.

Periodontal infection and inflammation and periodontal diseases arecaused by certain types of bacteria in plaque and calculus(concrements). These bacteria create toxins which irritate the gums andresult in a breakdown of the periodontal tissues that support the teeth.Over time, these toxins can destroy gum tissues, and allowing theinfection to progress can result in bone loss. There are many forms ofperiodontal diseases, the most common types being gingivitis andperiodontitis. Gingivitis is the earliest stage, and affects only thegum tissue. At this stage, the disease is still reversible.

If not treated, however, this disease may lead to more severe conditionscalled periodontitis. The gums, bone and other structures that supportthe teeth become damaged. Teeth can become loose and may have to beremoved. At this stage, the disease may require more complex treatmentto prevent tooth loss. With healthy gingiva (gum tissue), the teeth arefirmly anchored in bone. Gingivitis develops as toxins in plaqueirritate the gums, making them red, tender, swollen and likely to bleedeasily. Periodontitis occurs when toxins destroy the tissues and bone.Gums become detached from the teeth, forming pockets that fill with moreplaque. Advanced periodontitis is present when the teeth lose thesupporting bone. Unless treated, the affected tooth frequently becomesloose and may fall out.

The method of treatment of periodontal diseases depends upon the type ofdisease and how far the condition has progressed. Conventionally, thefirst step is usually a thorough cleaning which may include scaling toremove plaque and calculus deposits beneath the gum line. Surgery may berequired when deeper pockets, usually over 4 to 6 mm, are found. It isdifficult for the dentist or hygienist to thoroughly remove plaque andcalculus from deep pockets. Patients can seldom keep them clean and freeof plaque. Allowing pockets to remain may invite infection and bonedestruction. When pockets are deep and bone has been destroyed, flapsurgery may be necessary to provide access to the surfaces of the toothroots in order to thoroughly remove calculus, plaque and any diseasedtissue, and to recontour the bone to a more favorable architecture. Inthis technique, the gum is lifted away and is then sutured back intoplace or into a new position that will be easier to keep clean.Conventionally, surgical debridement of the tooth root surface and theremoval of granulation and granulomatous tissue are performed followingthe resection of the soft tissue flap. Aesthetic modifications of thisapproach have been reported under the title of open flap curettage,reverse bevel flap surgery, Widman flap surgery and modifications ofWidman flap surgery, apically positioned flap osseous surgery, andguided tissue regeneration.

Nevertheless, conventional methods do not appear to provide anappropriate minimally invasive surgical method for the reduction of thedeep pocket, elimination of disease, reattachment of the gingiva to thetooth root surface and true regeneration of the attachment apparatus(new cementum, new periodontal ligament, and new alveolar bone) on apreviously diseased root surface.

Therefore, an example embodiment for addressing these concerns will nowbe described, with respect to FIG. 7.

Briefly, in FIG. 7, gingivitis and periodontitis are treated in bothadult and young patients. Reducing early, shallow and deep bony pocketsprovides for removal of diseased tissue, periodontal pathogens,pathologic proteins, and calculus and other concrements on the toothsurface. This provides for true regeneration of the attachmentapparatus. The process includes creating a gingival trough or flaparound the tooth with a contact laser fiber, and photothermallyrupturing, disassociating, separating, ablating, denaturing andvaporizing the diseased, inflamed, infected, bacteria-invaded, ulceratedpocket epithelium via selective photothermolysis. The process furtherincludes vaporizing or denaturing the inner marginal gum tissues andpocket epithelium and granulomatous tissue fully around the targetedtooth to the accessible depth of the defect without breaking through thesoft tissue attachment apparatus above the depth of the bony defect,ultrasonic debridement of the tooth and root surfaces, transitioning tothe full depth of the bony defect via blunt dissection through any softtissue attachment and perforating into the bony defect, modifying thebone through osteoplasty and/or ostectomy below the level of themucoperiosteum as needed, creating angiogenesis, lasing the pocket todisinfect and decontaminate the soft and hard tissues, assisting inhemostasis, cauterizing free nerve endings, sealing lymphatics,preparing the coronal soft tissue for approximation against the toothand root, and compressing the soft marginal tissues against the toothand root, adhesion is achieved, and a stabilized fibrin clot has formed.In one example, elimination of occlusal interferences and occlusaltraumatic forces is typically achieved by occlusal adjustment.

By virtue of this arrangement, it is ordinarily possible to treatgingivitis and periodontitis periodontal pocket defects in both adultand young patients by establishing a new cementum-mediated periodontalligament attachment to the root surface in the absence of longjunctional epithelium and achieving true regeneration of the attachmentapparatus (new cementum, new periodontal ligament, and new alveolarbone) on a previously diseased root surface. Moreover, the inflamedpocket epithelium is selectively separated via photothermolysis,ordinarily without substantially removing any connective tissue.

The procedure may be indicated when, for example, there is amoderate-to-deep probed pocket depth of five mm or greater, as measuredfrom the coronal aspect of the tissues to the extent of the probablepocket, or when there is the presence of bony defects, or when there isinfection in the gingival tissue, notably presence of bleeding and/orsuppuration, or mobility of the teeth, or other aestheticconsiderations.

In more detail, in step 701, patient and dentist (clinician) data isloaded into tablet 400. For example, a dentist may enter logincredentials into a eGUI to identify his/herself, and may further enteran ID number, name, or other identification information to load datacorresponding to a patient.

In step 702, tablet controls are enabled, corresponding to the dentistdata. As mentioned above, an eGUI on tablet 400 may be configured suchthat the dentist who is in the midst of completing his/her training willhave access to only the features of the main laser computer 300/laser103 for the LANAP® protocol that he/she learned at that point intraining, commensurate with the dentist's level of clinical proficiency.

At this point, a number of preliminary procedural steps may beperformed. For example, gingival tissue of a patient corresponding to atargeted tooth can be anesthetized.

In that regard, a topically placed anesthetic is used to anesthetize thearea. In one example, the dentist may begin with 4% Prilocaine Plain™,using a 30-gauge needle. This anesthetic is perceived by the patient aspainless, due to its unique ability to anesthetize soft tissue withoutstinging. The anesthetic is injected very slowly into the area, allowingseveral minutes for the Prilocaine Plain™ to take effect. The dentistmay then continue using a 30-gauge needle, and follow this procedurewith a suitable longer-acting anesthetic. However, an exception would bemade if health reasons caused the anesthetic to be contraindicated. Thearea of concern usually involves LANAP® Protocol treatment of twoopposing quadrants and then the other two opposing quadrants some dayslater, or alternatively, full-mouth treatment in one appointment.Anesthesia is routinely used in every procedure, in order to: aid inbone-sounding (discussed below) for accurate measurement of the fulldepth of the diseased pocket and bony defects; allow aggressivedebridement of soft and hard tissues around the surfaces of the tooth;allow the patient to be as comfortable as possible during the treatment,thereby minimizing the patient's endogenous adrenaline production, andin turn achieve the optimal therapy results; maximize the doctor'sability to concentrate on the procedure; and optimize the use ofultrasonic probes at frequencies between one hertz and fifty thousandhertz.

As another preliminary step, bone sounding and pocket depth measurementcan be performed using a periodontal probe, recording the depths of allbony defects in the soft tissue around the tooth and root, from an uppergingival margin to the extent of the accessible bony defect. In oneexample, pocket depths can be recorded with a periodontal probe with sixareas recorded around each tooth root. This will allow a determinationof the full depth of the diseased pocket. The dentist uses the sum totalof all 6 probe depths/bone soundings and multiplies that number by 1 to40, depending on soft tissue phenotype (biotype), LANAP® PeriodontalDisease Case Type Classification I-V, and LANAP® Tooth Mobility Score0-4 (or other periodontal disease classifications or tooth mobilitymeasures), to compute a “light dose” of 1 to 40/Joules per millimeterpocket depth. Such tooth mobility measures may, for example, includemodifications to the Miller Index of Tooth Mobility or other measures.Such periodontal disease classifications may, for example, include theclassifications specified by the 1999 International Workshop for aClassification of Periodontal Diseases and Conditions or any futureupdates thereto: gingival diseases (dental plaque-induced gingivaldiseases, non-plaque-induced gingival lesions; chronic periodontitis(localized, generalized); aggressive periodontitis (localized,generalized); periodontitis as a manifestation of systemic diseases(associated with hematological disorders, associated with geneticdisorders, not otherwise specified); necrotizing periodontal diseases(necrotizing ulcerative gingivitis, necrotizing ulcerativeperiodontitis); abscesses of the periodontium (gingival abscess,periodontal abscess, pericoronal abscess); periodontitis associated withendodontic lesions (combined periodontic-endodontic lesions);developmental or acquired deformities and conditions (localizedtooth-related factors that modify or predispose to plaque-inducedgingival diseases/periodontitis, mucogingival deformities and conditionsaround teeth, mucogingival deformities and conditions on edentulousridges, occlusal trauma). (For example: 6 probe depths of 10 mm each=60mm total×1=60 Joules of total light dose.) The summation number of theprobe depth represents the TOTAL Joules to be delivered. The majority ofthe total light dose is applied during the 1st Step of laser applicationin LANAP® Ablation, while the remaining amount of the energy isdelivered during the 2nd laser application in the LANAP® Hemostasissetting. (In the example above, 40 Joules are delivered during theLANAP® Ablation Step, and 20 Joules are delivered during the LANAP®Hemostasis Step). Thus, a light dose computation is made in conjunctionwith the surgical treatment.

In that regard, tooth mobility measures may, for example, includemodifications to the Miller Index of Tooth Mobility or other measures.Such periodontal disease classifications may, for example, include thoseclassifications specified by the 1999 International Workshop for aClassification of Periodontal Diseases and Conditions or any futureupdates thereto:

Gingival diseases (dental plaque-induced gingival diseases,non-plaque-induced gingival lesions)

Chronic periodontitis (localized, generalized);

Aggressive periodontitis (localized, generalized);

Periodontitis as a manifestation of systemic diseases (associated withhematological disorders, associated with genetic disorders, nototherwise specified);

Necrotizing periodontal diseases (necrotizing ulcerative gingivitis,necrotizing ulcerative periodontitis);

Abscesses of the periodontium (gingival abscess, periodontal abscess,pericoronal abscess);

Periodontitis associated with endodontic lesions (combinedperiodontic-endodontic lesions); and

Developmental or acquired deformities and conditions (localizedtooth-related factors that modify or predispose to plaque-inducedgingival diseases/periodontitis, mucogingival deformities and conditionsaround teeth, mucogingival deformities and conditions on edentulousridges, occlusal trauma).

In one example, defect measurements (mm pocket depth) are provided totablet 400 for computation and recommendation of light dose, and arestored by patient name and tooth location at data appliance 427. In oneembodiment, the defect measurements are gathered by interfacing withelectronic medical (dental) record systems where the defect measurementshave been previously recorded, such as data appliance 427. In oneexample, the light dose recommendations are further modulated (adjusted)based on examples of the physical characteristics of the tissue(phenotypes) presented visually on the tablet 400 and selected by theclinician to indicate the tissue characteristics presented by thepatient. These phenotype selections can be used to compute therecommended light dose in the tablet 400.

In step 703, selective ablation is performed. In this regard, ablationof the free gingival margin with the laser energy via selectivephotothermolysis removes pathogens and pathologic proteins within thetissue of the free margin, which otherwise would not be removable,whereas lasing the pocket tissue surface around the affected tooth (step705) is used to, e.g., remove only granulomatous tissue, intentionallyleaving the disinfected granulation tissue in place, and to disinfect,assist in hemostasis, cauterize free nerve endings, and seal lymphaticsof the pocket tissue surface.

Thus, using laser delivery system 103, there is selective rupturing,disassociating, separating, ablating, denaturing and vaporizing of aninterior diseased epithelial lining of the pocket, to the soft tissueextent of the pocket on all sides of the tooth, to establish a newcementum-mediated periodontal ligament attachment to the root surface inthe absence of long junctional epithelium and achieving trueregeneration of the attachment apparatus (new cementum, new periodontalligament, and new alveolar bone) on a previously diseased root surface.In one example, ablating, denaturing and vaporizing is completed withnot more than 6.00 Watts of average output power from the laser, asmeasured at the distal end of a laser fiber, and with a lasing frequencyof not more than 100 Hz.

Laser delivery system 103, such as manufactured by Millennium DentalTechnologies, Inc., for their model number “PerioLase® MVP-7™” operatingat a wavelength in the near-infrared of, e.g., 1000 to 2000 nanometers,is used to create the initial trough or flap at the marginal gingivausing between, e.g., one and six Watts of average fiber output power(measured at the distal end of the fiber), and frequencies between oneand one hundred hertz. A contact laser fiber (e.g., the fiber in cannula502) with a fiber diameter of between 200 (microns) and 1000 (microns)can be used, in an orientation parallel to the surface of the toothroot, to create a gingival trough or flap by ablating the free gingivalmargin and the internal diseased epithelial lining of the pocket, thusexposing the tooth root surface and removing all internal epitheliallining from the periodontal pocket.

An appropriately cleaved contact laser fiber is used for the precisecontrol of the laser energy, the physical placement of the laser energy,and the determination of the desired orientation of the laser to thetissue desired to be removed. Orientation parallel to the surface of thetooth root defines the direction of the laser fiber for the properinitial tissue selective ablation. The tooth root surface is thenexposed for viewing by a gingival trough or flap.

Ablation of the free gingival margin with the laser energy via selectivephotothermolysis removes pathogens and pathologic proteins within thetissue of the free margin, which otherwise would not be removable.Lasing the tooth and root surface destroys the lipopolysaccharides (LPS)of gram-negative bacteria. Additionally, this procedure provideshemostasis, and further defines the tissue margins precedingpiezo-electric instrumentation. The integrity of the mucosa is alsopreserved prior to mechanical manipulation, thereby dissecting theseparation between the free gingival margin and the fibrous collagenmatrix, which holds the gingiva in position. Maintenance of the crest ofthe gingival margin is aided in that the healing of the fibrous collagenmatrix will maintain the gingival crest at, or apical to, thepresurgical level.

By use of the “hot-tip” effect (accumulated tissue proteins heated viaconductivity secondary to the passage of laser energy through thefiber), the dentist may continue to excise the inner pocket epitheliumaround the entire tooth and root to the depth of the probed reading, butnot using the laser or the optical fiber to break through themucogingival junction. This effect provides the selective removal ofsulcular, pocket epithelium and granulomatous tissues without removingany substantial connective fibrous tissue and does so circumferentiallyand radially. As necessary, the dentist may remove the excised tissuethat accumulates on the tip of the laser fiber.

Using the quartz optical fiber oriented less than 30 degrees to thetooth root surface, the clinician may lase the tooth and root surface todestroy lipopolysaccharides (LPS). Greater than 30 degrees risks thepossibility that the Nd:YAG laser pulse may interact with the surface ofthe tooth root. A few pulses of Nd:YAG laser energy are not injurious toa tooth root as long as the irradiation is immediately discontinued sothat heat does not accumulate within the tooth. The nature of a quartzoptical “bare” fiber is such that it has a 27-degree beam divergence.Therefore, even parallel to the root surface, the Nd:YAG laser radiationcan reach the surface by “side-firing” scatter.

Thus, there is separation of the inner pocket diseased epithelium aroundthe entire tooth root to a depth equal to an initial probe reading ofthe inner pocket, followed by an ultrasonic scaling of fixture surfacesand blunt dissection of any soft tissue adhesions or attachments throughto the bony defect.

In step 704, cleaning is performed with, e.g., an ultrasonic handpiece,along with further cleaning by laser delivery system 103. In particular,the tooth and root surface is cleaned of all foreign matter, to the fulldepth of the pocket on all sides of the tooth from crestal margin tobony base. For example, the dentist may use an ultrasonic handpiece toultrasonically scale all tooth and root surfaces to the depth of thepocket, with the intent to remove all foreign structures and substancesfrom the tooth and root surface (including the bacterial smear layercovering and included in soft and hard tissue calcification, calculus,concrements and cement), thereby allowing adhesion of the lased softtissue to the clean tooth and root surface. Bone modification, asappropriate with osteotomy and/or ostectomy, may be undertaken. Then,using laser delivery system 103, between one and six Watts of laserfiber output power and a frequency between one hertz and one hundredhertz may be used in the deep periodontal pockets for optimal bacterialdestruction without causing bacterial injection into the periodontaltissues. This will minimize the occurrence of soft tissue cellulitis.

In step 705, lasing is performed with laser delivery system 103, toremove only granulomatous tissue, intentionally leaving the disinfectedgranulation tissue in place, and to disinfect, assist in hemostasis,cauterize free nerve endings, and seal lymphatics of the pocket tissuesurface, and to prepare the pocket tissue surface for adhesion. Laserdelivery system 103 may also be used to stop blood flow as needed.

Therefore, as described above, the procedure further includes cleaningand lasing of the pocket in preparation for soft tissue adhesion.

In one example, the ablating, vaporizing, and lasing are completed witha laser fiber oriented parallel to the surface of the tooth root. In afurther example, the laser fiber diameter is between, e.g.,approximately 200 and 1000 microns.

In one specific example, although the disclosure is not hereby limited,laser delivery system 103 might comprise a FiberFlex™ 360-microndiameter quartz optical fiber fed through a handpiece such as ananodized aluminum TrueFlex® handpiece and bendable cannula. The dentistactivates the laser to intentionally irradiate the bone at the base ofthe bony defect in the 6 separate pocket depth measurement locations toinitiate hemostasis from the medullary bone, stimulate and upregulatethe release of growth factors (e.g., IGF-I and IGF-II, TGF-beta 1,TGF-beta 2, BMP-2), stimulate and upregulate fibroblasts and stem cells,warm the blood in the pocket to thermolytically cleave fibrinogenthereby converting the blood into fibrin (thrombin catalyzes theconversion of fibrinogen to fibrin), the body's first connective tissue,create a stable fibrin clot, and to create angiogenesis (newvascularization); to remove and/or denature any remaining, residualgranulomatous tissue, and inflamed, infected and diseased epitheliallining, intentionally leaving granulation tissue in place (stem cells,capillaries, fibroblasts), but disinfected; and to, e.g., cauterize freenerve endings and seal lymphatics of the pocket tissue surface, and toprepare the pocket tissue surface for adhesion.

Following the lasing, a number of follow-up steps may be performed. Inparticular, the pocket may be irrigated with a bactericidal solution,occlusal interferences may be eliminated, and the pocket tissue may alsobe lased, to adapt the pocket tissue surface for tissue adhesion. In oneexample, all treatment sites are irrigated to the deepest depth of theperiodontal pockets with a bactericidal solution of a high tissuesubstantivity (e.g., chlorhexidine gluconate 0.12%). The irrigation aidsthe laser in the reduction of bacteria in the pocket and in removingdebris. In one example, a high-speed handpiece for occlusal adjustmentis used to eliminate occlusal prematurities and interferences andocclusal traumatic forces. In some instances, an anterior deprogrammerand dis-occluding occlusal splint may be necessary when trauma-inducedperiodontal disease is manifest, i.e., occlusal trauma in the absence orpresence of bacteria-induced periodontal disease. The splint is designedto provide anterior guidance, e.g., a “LANAP Splint”, or anterior “jig”.

The pocket tissue surface can be approximated with the tooth and rootsurface and the pocket tissue surface can be maintained in contact withthe tooth and root surface to advance adhesion. In addition, the processcan include applying firm pressure to hold the pocket tissue surface incontact with the tooth and root surface for one to three minutes,allowing a thin clot to form between the pocket tissue surface and thetooth and root surface. Put another way, the tissues should becompressed with firm pressure for one to three minutes against the toothand root from both a facial and lingual direction, permitting only athin clot to form between the tissue and the tooth and root.

In addition, follow-up steps can include prescribing medications foroutpatient use in preventing infection, providing ongoing occlusalequilibration examination, and enhancing the patient's natural immunesystem (e.g., through medication) to protect against infection andreduce inflammation.

In step 706, the patient and dentist data is updated to reflect theperformance and outcome of the procedure.

The procedure can be categorized as a Surgical Flap Procedure and“Laser-Assisted Regeneration”, with limited or complete occlusaladjustment. In some examples, a time of 45 minutes is reasonable totreat a quadrant. As suggested above, treatment can be followed by acoronal polishing/prophylaxis and an occlusal equilibration follow-upand a postoperative check of the area treated.

Thus, as described above, the laser-assisted periodontal device is alaser periodontal, periodontitis, gingivitis, treatment device for useon both adult and young patients.

According to one example aspect, creating a gingival trough or flaparound a tooth includes creating a circumferential and radial softtissue, gingival, or mucosal trough or flap around a tooth.

According to still another example aspect, photothermally rupturing,disassociating, separating, ablating, denaturing and vaporizing theinfected tissue comprises ablating or denaturing inflamed, infected,erythematous, edematous, hyperplastic, bacteria-invaded, ulcerated,degenerated, bleeding, suppurative, or sloughing periodontal softtissue, including sulcular epithelium, junctional epithelium, andkeratinized tissue, via selective photothermolysis.

According to another example aspect, the method can be accomplishedusing a blue light device with wavelength emission in the range of 400to 520 nm (e.g., 405, 420, 425, 470 nm), such as a diode laser,Ti:sapphire laser, argon ion laser, light-emitting diode,superluminescent diode, halogen, plasma-arc curing (PAC), or other lightsource to simultaneously, sequentially, or singularly irradiate thetissues to kill or inactivate bacteria, spores, fungi, viruses, andbacteriophages and to suppress biofilm formation.

In one aspect, the blue light device irradiation is co-axial with anaiming light for guiding the laser. In another example, the blue lightdevice comprises a separate energy source and a separate handpiece fromthat of the laser. Thus, the blue light device can be combined with, orcompletely independent from, the hardware comprising the laser.

According to yet another example aspect, there is control to perform astep of circumferentially and radially irradiating surfaces of the toothand root to denature or ablate bioactive bacterial products includinglipopolysaccharide endotoxins.

According to another example aspect, the method includes diagnosing andassessing the effectiveness of treatment over time by such means asclinical examination, laboratory tests, noninvasive tools (includingoptical coherence tomography, infrared spectroscopy, acousticmicroscopy), and other techniques.

Graphical User Interface

FIGS. 8 to 67 are views for explaining a graphical user interface (eGUI)according to example embodiments.

In that regard, FIGS. 8, 9 and 10 depict screens associated with astart-up procedure.

In one example start-up procedure, a main breaker switch (not shown),which is at the rear of main laser computer 300, should be in the OFF(O) position. A key is inserted and left in the OFF or vertical position(|), and a power cord is plugged into 120 VAC main power and to the rearof the main laser computer 300. Footswitch 314, fiber cannula 502, andan interlock plug (not shown) are manually connected. In one exampleembodiment, a wireless footswitch 314 may not have a cable connectorattached like a standard footswitch. If so equipped, the wirelessfootswitch 314 can be activated using, e.g., a selector toggle switch onthe back of the main laser computer 300 that indicates WIRELESS.

In the example start-up procedure, tablet 400 is powered on by pressingand holding a tablet power button on the upper left side of the tablet400, until a start-up image 801 (shown in FIG. 8) begins to appear andtablet 400 initiates a boot-up process. At this time, main lasercomputer 300's main breaker (rear) can be turned to ON (|).

The main laser computer 300 splash screen 901, shown in FIG. 9, mayautomatically appear. A key switch can be turned to the horizontal (−)position, and a loading icon may momentarily appear at the upper rightof the screen. The procedure then proceeds to a LOGIN screen 1001, shownin FIG. 10. As can be seen in FIG. 10, LOGIN screen 1001 includes alogin window 1002 for a user to enter a username and password (e.g., asshown below), as well as a keyboard 1003 by which to enter thisinformation. In one example, a user may select a username bar with afinger on touch screen 408, and keyboard 1003 may appear at that time.The user then uses keyboard 1003 to enter username and password. Afterthat, the user may select the LOGIN button on login window 1002 tosubmit the information for verification. After a logout or switch usersprocedure, the LOGIN screen 1001 can be displayed again.

In one embodiment, the login credentials for the user may fall into fourmain categories: “Clinician” (e.g., a dentist or other user of themachine), “demo” (e.g., a demonstration mode for showing features of theproduct), “BootCamp” (a training mode in which user rights are limited),and a “service” mode for maintenance and other administrativeprocedures. Example usernames, password attributes, and rights for eachare as follows:

LOGIN CREDENTIALS USERNAME PASSWORD RIGHTS Clinician As Assigned Accessas trained demo password all procedures BootCamp password 360-μprocedures only no overrides service service access to SERVICE MODES 1&2

As mentioned above, tablet 400 displays four primary control surfaces.These control surfaces include (in order from left to right):Procedures, Home, Patients, and Admin.

For first-time users, tablet 400 may allow the user to set up certainHOME screen features according to one's preference(s). This may include,for example, going to the Admin screen to select the time zone, autopower measurement mode, and start-up configuration check box options.Initial home Screen setup may include adding Patient data such as thepatient name (first and last), and patient case number.

FIG. 11 is a view for explaining operations on a “Home” screen controlsurface 1101. As mentioned above, a home screen allows main command andcontrol functionality, including control of patient management and ofmain functionality of the laser. As shown in FIG. 11, control surface1101 allows a user to select a patient name. In that regard, the eGUIrecords treatment data which can be assigned to specific patients. Theuser can select a Patient Name icon bar 1103, and a separate pop-up box1102 will appear with a drop-down list of selectable patient names. Uponselecting the Patient Name icon bar 1103, the user has a choice betweentwo options. The first option is the default setting which is labeled asNo Specific Patient, and is listed as the first option in the drop-downlist.

In addition, a help icon 1104 is accessible to the user on all 4 mainscreens of the eGUI. By selecting this icon, the user is displayed a pdfattachment of all the functions and features of all the 4 main eGUIscreens.

FIG. 12 shows another home screen control surface 1201, with a secondoption for selecting a patient. In particular, as shown in FIG. 12, thesecond option is a list of patient names that will appear inalphabetical order on the drop-down list 1202. The patient names thatare displayed here are designated from the Patient Management/Reportingcontrol surface.

FIG. 13 is a view for explaining a control surface 1301 for procedurenames and error messages. In particular, when a user selects a presetprocedure from a Preset Procedures screen (which can be accessed by aright swipe from the home screen and is depicted in, e.g., FIGS. 14 and49), the procedure the user has selected from this screen will be ableto be seen on the home screen to the right of the Patient Name Icon Bar(here, “LANAP Hemostasis”). Control surface 1301 also includes adrop-down display of fiber diameters for laser delivery system 103, andan image of quadrants of the mouth 1303 which might be subject to theselected procedure. In addition, fiber diameter icon bar 1302, locatedat the upper right side of the home screen, is selectable so that adrop-down list of selectable fiber diameters in microns will appear, asdiscussed more fully below.

In another example, if the user has selected a LANAP® First Pass fromthe Preset Procedures screen, then that procedure will appear betweenthe Patient Name icon bar and the Fiber Diameter icon bar. In thatregard, FIG. 14 is a view of an example preset procedures screen 1401.As shown in FIG. 14, a selected fiber diameter 1402 corresponds to alist of preset procedures 1403 for that fiber diameter, which can thenbe selected by, e.g., tapping on the procedure. Certain procedures mayhave associated video or photos depicted by icons such as icon 1404, toassist in performing the procedure.

FIG. 15 is another view of the home screen, indicating a home screencontrol surface 1500 displaying an error code. Specifically, at location1501, home screen control surface 1500 displays an error code 89. Thus,error messages appear in this location on the Home Control surface. Apop-up indication 1502 indicates that the error message is also beingcopied to a clipboard for later access. Examples of error codes areshown below, although it should be understood that these are merelyexamples, and other error codes or error conditions may be used:

CODE MEANING “INT” Interlock circuit is open (Standby Mode) “TEM”Temperature is >70 degrees C. (Standby Mode) “FSW” Footswitch ispartially or fully active (Standby Mode) “FIB” Fiber is missing (StandbyMode) “INTERLOCK” Interlock circuit is open (non-Standby Mode)“TEMPERATURE” Temperature is >70 degrees C. (non-Standby Mode) “FIBER”Fiber is missing (non-Standby Mode) E81 Fiber sensor is stuck in the ONstate E82 Temperature sensor indicates <2 degrees C. E83 Temperaturesensor indicates >80 degrees C. E84 Coolant flow switch is closed whenthe pump should be off E85 Coolant flow switch is open when the pumpshould be on E88 Insufficient energy detected during firing E89Excessive energy detected during firing E90 High voltage present when itshould not be E93 Energy detector calibration factor corrupted

FIGS. 16 to 20 are views for explaining a preset procedure overwrite,which allows the user to overwrite the therapeutic parameters of thePreset Procedures listed on the Preset Procedures Screen. To enable thisfeature, the user must select a Preset Procedure from the PresetProcedures Screen. The Preset Procedures screen can be accessed by aright swipe from the home screen. A user may select a preset procedureby, e.g., “clicking” or tapping on it, and be automatically brought backto the home screen after the desired preset procedure has been selected.

As shown in FIG. 16, a control surface 1601 for the home screen in thepreset procedure overwrite depicts icons showing the therapeuticparameters or the energy settings: pulse duration in μsec 1605,instantaneous energy in mJ 1606, and pulse repetition rate in Hz 1607 ofthe Preset Procedure, which can then be manipulated by using the (+) and(−) symbols (e.g., 1603 and 1604) next to each parameter. In addition,fiber diameter icon bar 1602, located at the upper right side of thehome screen, is selectable so that a drop-down list of selectable fiberdiameters in microns will appear, as discussed more fully below. FIG. 17depicts a control screen 1701, where the therapeutic parameter settingsof LANAP Hemostasis, namely, 550 μsec, 180 mJ, and 20 Hz have beenchanged to 650 μsec, 190 mJ and 30 Hz as shown in FIG. 18.

In one example, as shown in FIG. 18, after the user makes a change inthe therapeutic parameters and performs a long press on the PresetProcedure (located in between the Patient Name and Fiber Diameter iconbars), a separate pop-up box 1802 will appear on a control screen 1801that includes a “Stand By” indication 1803 and a message box 1804stating: “Overwrite Procedure Parameters, Please Confirm.” The user isprovided with icons 1805, 1806 and 1807 to select to proceed, return todefault parameters, or cancel, respectively. If the user selects the Okicon 1805, the therapeutic parameters or corresponding energy settingsare saved in accordance with the changes selected.

FIG. 19 is another view for explaining a preset procedures restore. Inthat regard, there are two ways that the user can restore the treatmentpreset procedure(s) back to their original default settings. The firstoption is to restore the preset procedure individually, from the homescreen surface. To initiate a preset procedure restore, the user selectsthe preset procedure to restore to factory default settings from theprocedures screen, and is brought back to the home screen. In oneexample, a long press on the Preset Procedure (located in between thePatient Name and Fiber Diameter icon bars) causes the message box 1804stating “Overwrite Procedure Parameters, Please Confirm” to appear as aseparate pop-up box, again. The user is again provided with icons 1805,1806 and 1807 to select to proceed, return to default parameters, orcancel, respectively. If the user selects the icon 1806, the therapeuticsettings are restored to their default settings.

FIG. 20 is a view for explaining another option for restoring defaultsettings. In particular, FIG. 20 depicts a control surface 2001 which isobtained by swiping to the “Admin” screen (explained above) andselecting a Control Panel tab. At the bottom of the surface 2001 is anicon bar 2002 that displays “Restore Default Therapeutic ParameterSettings”. Upon selection of this feature, all the therapeutic parametersettings that have been previously overwritten will go back to theiroriginal default settings.

FIG. 21 is a view for explaining selection of a fiber diameter. Inparticular, in the updated home screen 2101, the user has selected theFiber Diameter icon bar 2102 which is located at the upper right side ofthe home screen. A drop-down list 2103 of fiber diameter in microns willappear: 300μ, 360μ, 400μ (in some examples, fiber diameters arecolor-coded on the home screen). The user may then select the fiber thatcorresponds with the one presently installed. In that regard, in certainembodiments, only certain login credentials can access certain fiberdiameters.

FIGS. 22 to 29 are views for explaining control of energy settings.

In particular, FIG. 22 is a view individually showing an Energy icon bar2201 which is included on the various home screens (e.g., FIG. 11, FIG.13, etc.). Energy icon bar 2201 is a control grouping which changes thetherapeutic parameter settings. The fundamental therapeutic parametersare average power (P_(A)) 2203, Pulse Duration in microseconds (μsec)2204, Energy in millijoules (mJ) 2205, and pulse repetition rate 2206,in pulses per second (Hz). The user can change the primary therapeuticparameter settings individually by selecting μsec, mJ, and Hz bypressing the adjacent (+) and (−) icons. In addition, by selecting thestand-alone icons for energy 2202 or P_(A) 2203 with correspondingimages depicting sliders for various parameters, the user can accesssets of the different parameters at the same time, and scroll through tosee their relationships and allowed/disallowed values for eachparameter, depending on the settings of the other parameters.

Specifically, as shown in FIG. 23, to visualize the relationshipsbetween the fundamental therapeutic parameters after selecting theEnergy icon bar, a pop-up box 2302 will appear on the control surface2301 with three different columns from left to right: μsec column 2303,mJ column 2304, and Hz column 2305. Settings that have an “unlocked”lock icon 2306 (which may be colored, e.g., green) next to them indicatethose parameters which are available to be selected, whereas parameterswith a “locked” lock icon 2307 (which may be colored, e.g., red)indicate that those values are currently prohibited, at least with theother parameters at their current settings. Using a finger, the user mayscroll up and down within a parameter column to observe values above orbelow those presently displayed. A user may change from among the threefundamental therapeutic parameters and observe the corresponding averagePower, P_(A), values. A user may also select a set button 2308 to acceptdesignated set of therapeutic parameters, or a cancel button 2309 toreturn without changes.

FIG. 24 is a view for explaining a control surface 2401 for providing anoverride feature of energy settings (therapeutic parameter settings)with a red lock icon (e.g., lock icon 2403 for Hz setting 2402) that maybe selected using an override procedure. To initiate the overridefeature, the user must select the therapeutic parameter (whether it ismJ, or Hz) that has the red locked icon. Once selected, the therapeuticparameter with the red locked icon may change display (e.g., turn“unlocked” and green). Meanwhile, other therapeutic parameters allowedusing this override condition will be designated with a revised set ofgreen unlocked icons. A user may also select a set button 2404 to accepta designated set of therapeutic parameters, or a cancel button 2405 toreturn without changes.

FIGS. 25, 26 and 27 are views for explaining another feature calledaverage power hold, which can be accessed in the Energy icon bar (e.g.,by selecting icon 2502 or icon 2503 on bar 2501 in FIG. 25).

Turning to FIG. 26, at the top of the pop-up box on control screen 2601,the Average Power 2602, P_(A), value can be seen along with an icon 2603that looks like a thumbtack next to it.

Selecting the thumbtack icon 2603 next to the P_(A) will fix the averagepower value. Selecting another Pulse Repetition, Hz, from list 2606 willchange to a corresponding energy value in millijoules, mJ, which willmaintain this average power value. Likewise, after the user changes anenergy value, mJ, from list 2605, or changes a duration value in μsecfrom list 2604, the system will select the corresponding pulserepetition, Hz, to maintain the designated P_(A) value.

The Average Power Hold feature is also available on another part of thehome screen, as shown on control screen 2701 in FIG. 27. Specifically,under the Timer/Info icon bar, the user is provided with the option ofselecting Info Average Power P_(A) icon 2703 on the drop-down list nextto P_(A), and can also see the Average Power hold thumbtack feature icon2704. If the user fixes the P_(A) value by selecting the thumbtack icon2704 the user may thereafter change either Hz or mJ using the +/− iconbars 2705 and 2706, and the system maintains the P_(A) value fixed bythe thumbtack. This value may also be shown on the same screen by P_(A)icon 2702.

Turning to FIGS. 28 and 29, the Average Power, P_(A), can also bedirectly designated when the clinician selects the icon P_(A), e.g.,either P_(A) numerical display 2902 or parameter shift image 2903 on theenergy icon bar 2901. Turning to FIG. 28, the pop-up window 2802correspondingly displayed on a screen 2801 has a thumbwheel controlusing a rolling up-and-down motion. The first step is to select thedesired Average Power, Watts, using the center thumbwheel 2804.Available combinations of mJ and Hz can now be selected for this P_(A)using the thumbwheel 2805 on the right. The user may also use the leftside thumbwheel 2803 to select from the available pulse durations, μsec,to complete the selection. The user is also provided with a set button2806 to set the parameters, and a cancel button 2807 to cancel theoperation.

Thus, the thumbwheel visual allows for a convenient visualization ofparameters and their relationship. For example, having set one parameter(or a separate value such as P_(A)), the user is provided with anotherthumbwheel by which to choose other parameters. In addition, in oneexample, the user may set an average power for the laser via a userinterface on the tablet, and then select from a set of permissible laserparameters provided in response to the selected average power.Accordingly, it is ordinarily possible for a user to, for example, workbackward to select laser parameters from the average power, rather thanrelying on trial and error.

FIGS. 30 to 33 are views for explaining light dose tracking and displayaccording to example embodiments. As mentioned above, a light dose chartmay show an amount of laser dosimetry over time, as well as a lineindicating the maximum dosage allowed for that tissue/procedure. Forexample, the procedures screen may, using information from the patientrecords, determine a disease being treated and a dosage administeredthus far, and display a “max” line on a graph, with a dosage line whichincreases in real time toward the maximum as further laser dosage isapplied.

FIG. 30 displays a Light Dose Chart icon 3001, which looks like a chartwith an upward pointing arrow, which may be displayed on a home screen.A user selects the Light Dose Chart icon to enable the Light Dosegraphing feature.

Specifically, upon selecting icon 3001, a control surface such ascontrol surface 3101 (depicted in FIG. 31) is displayed, with a pop-upwindow 3102 allowing a user to enter light dose values based on clinicaljudgment and training, by using the (+) and (−) near each digit 3103.Light dose settings permit an entry of up to four digits or 9,999joules/mm pocket depth. After the user has selected the Light Doseentry, the user may select to cancel using cancel button 3105, or selectthe Ok button 3104, after which a Light Dose graph appears.

In particular, FIG. 32 depicts a control surface 3201 with a light dosegraph that changes as the laser is fired. In that regard, FIG. 32 showsa state in which the laser is currently being fired. Icon 3202 indicatesthat the laser is currently being fired. To do so, the user might toggleSTANDBY to READY, depress footswitch 314, and fire the laser, and thenobserve the yellow laser warning light.

The light dose chart 3206 shows the amount of laser dosimetry applied sofar during this active laser session (e.g., during an instance ofpressing the footswitch), using a line 3208, in Joules/time(s). At thesame time, a line 3207 shows the maximum allowable total joules whichcan safely or effectively be applied. This maximum allowable amount maychange in dependence on, e.g., the procedure being performed. In thatregard, additional lines may be displayed to show, for example, themaximum for particular phases of a multi-phase procedure, e.g., LANAP®Ablation or LANAP® Hemostasis.

The accumulation of Joules 3203 on the light dose graph is alsodisplayed on the right side of the home screen under the Timer/Info iconbar 3204. The user may opt out of the light dose tracking by selectingthe Light Dose Chart icon 3205 once more, after which the graph 3206will disappear from the home screen.

FIG. 33 shows a control surface 3301 including a Light Dose Chart 3302in Measure Power (P_(M)) Mode. While in the Measure Power, P_(M) Mode,the system does not allow the user to record any patient data. Rather,it is a tool for the user to utilize for power measurement of main lasercomputer 300. If the Light Dose graph feature is still enabled and thechart appears on the home screen, a watermark 3303 may appear across thegraph that will state Power Measurement Mode when the laser is firingand the footswitch is depressed. Meanwhile the power measurement display3304 shows the measured power.

FIGS. 34 to 39 are views for explaining information displayed inassociation with an instance of laser firing according to exampleembodiments.

In particular, FIG. 34 indicates a control screen 3401 for a pre-firingstandby state. Thus, as can be seen from FIG. 34, an icon 3402 indicatesthat the system is in standby mode, and, underneath the Timer/Info iconbar 3403, display 3404 indicates that an accumulation of Joules is atzero.

FIG. 35 shows a control screen 3501 for a state when a user toggles fromstandby to ready mode, just before firing (by depressing footswitch 314,firing the laser, etc.). An icon 3502 indicates the Ready mode. Theaccumulation of Joules 3504 on the dental arch will be displayed underthe Info/Timer icon bar 3503. Laser energy will be transmitted inaccordance with the therapeutic parameters selected via the opticalfiber.

FIG. 36 illustrates a control surface 3601 for setting a timer. Inparticular, when the user selects “Timer” on the drop-down bar 3605, aseparate pop-up box 3602 will appear showing the desired minutes 3603and seconds 3604 to be entered by (+) and (−) symbols.

FIG. 37 shows a control screen 3701 after the selection of desired time,in which countdown timer indicators, such as minute wheel 3702 withticks 3703 and second wheel 3704 with ticks 3705, will appear below theTimer icon bar 3706. When the footswitch 314 is depressed, the ticks onthe appropriate timer will decrease according to the selected time. Toexit from the countdown timer, the user may select the Timer icon bar3706 once more.

FIG. 38 illustrates a control screen 3801 for displaying variousaccumulated information according to an example embodiment. Inparticular, when a user selects Info/Average Power from the drop-downbar 3803, the laser parameters information table 3804 appears. Thesevalues in laser parameters information table 3804 may change when thefundamental laser parameters change and/or the selected fiber diameteris changed. On the other hand, thumbtack element 3802 allows the user to“pin” certain values such that other parameters are forced to change tofit.

The parameters in laser parameters information table 3804 include:

E_(D), Energy Density (3805): E_(D)=Energy Density (depends on fiber andmJ settings only). E_(D) is Joules/cm². E_(D) may be held constant whilethe fiber diameter is changed and in fact by replacing the optical fiberon the front of the laser to the corresponding diameter value. There isa thumbtack pinning feature for Energy Density. The icon 3802 for thisfeature is located on the left side of E_(D). Pinning E_(D) changes thefundamental therapeutic parameter, mJ, to maintain (as close aspossible) the energy density designated from the previous fiberdiameter. Pinning E_(D) and changing the fiber diameter will adjust mJto keep E_(D) approximately constant.

P_(A), Average Power (3806): =Desired Average Power.

P_(D), Power Density (3807): Average Power, Watts, per square millimeterof fiber diameter.

P_(P), Peak Power (3808): =Peak Power each laser pulse (depends on μsecand mJ only).

Turning to FIG. 39, when a user selects Info/Measure Power, (P_(M)) thisactivates the control screen 3901 in which the power measurement featureand the P_(M) display 3902 is highlighted (e.g., displayed in red) toemphasize that this feature is activated. This allows the user tomeasure the power output of the main laser computer 300. In the P_(M)mode the system does not write system data, like mJ, or Shots to thepatient records. P_(M) is a tool for the user to verify that the powersettings made in the eGUI are realized at the distal end of the opticalfiber nearest the surgical site. This is a comparison of the P_(A) andP_(M) values. If the Light Dose Chart 3903 pop-up window appears on thehome screen, there will be a watermark 3904 that will appear across thegraph that will state Power Measurement Mode when the footswitch isdepressed, as illustrated in FIG. 39.

FIGS. 40 to 45 are views for illustrating selection of groups, areas orregions of a mouth for treatment and tracking thereof according toexample embodiments.

FIG. 40 illustrates a control surface 4001 for allowing a user to selecta dental arch for which to record dosimetry. For example, a user mayselect and/or de-select the dental arch quadrant(s) labeled UR (4002),LR (4004), UL (4003), and LL (4005). When a specific quadrant isselected, the selected area will be highlighted on the HOME screen, asshown by indication box 4006, although this emphasis may also bedisplayed using, e.g., color in the selected area while displaying theother quadrant(s) as grayscale. When selected, as the UR quadrant shownhere, Tx data is tagged with this location and will be available foranalysis in the Patient Control Surface, Report Tab.

FIGS. 41 and 42 illustrate selection of a sextant. Specifically, thereis an option for the user to select a different dental arch which iscalled a sextant. A display control surface 4101 indicates the differentsextants labeled UAS (4102), URS (4103), ULS (4104), LRS (4105), LLS(4106), and LAS (4107). When a specific area of the dental arch sextantis selected, the selected area will be highlighted on the HOME screen.

Meanwhile, FIG. 42 illustrates one embodiment for changing to thesextant selection from an administration control surface 4201. Inparticular, the user selects or de-selects the Dental Arch Sextant Mode4203 from the administration control surface, control panel tab 4202.

FIG. 43 illustrates a control surface 4301 by which a user is allowed toselect a tooth location which can be denoted as an implant. In thatregard, when recording information to the dental arch location, thereare many options for additional specificity. Each of the teeth in thedental arch may be designated, individually or in ad hoc groupings ofmultiple teeth. Once designated, dosimetry data are labeled and recordedto these locations. There are options to select teeth individually or toselect multi-tooth grouping options.

The individual tooth selection feature applies to either quadrant orsextant dental arches. To enable this feature, the user performs a longpress on a particular quadrant/sextant. A pop-up box 4302 will appearwith a tooth carousel including teeth 4303, 4304, 4306 and 4307. Theselected tooth is highlighted with a red box 4305. The tooth carouselpop-up box has a left-right (LR) swipe functionality to allow the userto select the desired tooth.

When the user performs a long press on a specific individual tooth, asite condition designation window (FIG. 44) appears in a pop-up 4401 boxwith these options: Tooth Intact, Extracted, Crown, and Implant. Thedata for these site conditions will appear on the Reporting Controlscreen.

FIG. 45 illustrates a view of another tooth carousel 4501 for selectingsingle or multiple teeth (e.g., tooth 4502). In this example, selectedteeth appear with rectangles such as rectangle 4503 (which may becolored, for example, red). Each tooth with a rectangle will appear in atreatment group on the reporting control surface. The home screen showsthe tooth carousel multi-tooth feature with a display 4504 of 3 teethselected from the upper left quadrant for this example. Teeth arelabeled as follows: tooth 10 i (tooth 10 selected with the sitecondition option Implant), tooth 11 c (tooth 11 with the site conditionoption Crown), and 12 x (tooth 12 with the site condition optionExtracted). When the user toggles the standby to ready buttons and thelaser is fired, the designated multi-tooth group is recorded in thedatabase for use in reporting and analysis. If the user wishes to switchfrom one tooth to another, the user may simply select the other tooth bydoing a short press on the tooth that was previously selected as part ofthe multi-tooth grouping.

FIGS. 46 to 48 are views for explaining selection and adjustment ofpresets according to example embodiments.

In FIG. 46, the Presets icon bar 4602 is located at the lower left partof the home screen 4601. This feature enables the clinician to recordand label all 3 of the fundamental therapeutic parameter settings (μsec,mJ, and Hz) which are presently set at the home screen. These can berecalled as needed.

FIGS. 47 and 48 depicts control screens which allow a user to name apreset with up to 8 alphanumerical characters, and to add new or selectfrom previously named and saved preset parameters. When the user selectsthe Presets icon bar 4602, a separate pop-up box 4702 will appear on theupdated control screen 4701, with options to save up to 10 or morepresets. At the top of the presets pop-up box 4702, directions for useare indicated: Touch Short to Select, Long to Edit. When the userselects the option to touch short to select, then the selected presetwill appear on the home screen at, e.g., in between the Patient Name andthe Fiber Diameter icon bars.

When the user selects the option touch long to edit, a separate pop-upbox 4801 as shown in FIG. 48 will appear, with 3 Preset options: whichare to store (option 4803), name (option 4804), and erase (option 4802),as follows:

Option to Store: When the user selects the option to Store, thetherapeutic parameter settings (or the energy icon) that are on the homescreen will be saved as Preset 1. The user may go back to the homescreen and change the therapeutic parameter settings by pressing the (+)and (−) icons, or by selecting the energy icon and selecting thetherapeutic parameters that appear on the pop-up chart. The chart isseparated in different columns from left to right, μsec, mJ, and Hz.After the user has made the appropriate changes in the energy settings,then the option to set the current settings prior to storage isselected. When the user wishes to store the energy settings that arecurrently on the home screen, the user must select the Presets icon bar.

Option to Name: The user selects a preset to name (e.g., Preset 3), thenuses the option Touch Long to Edit. The user selects the option name anda box will appear so that the user can type in the name of the Preset torename or personalize.

Option to Erase: The user selects a preset to erase, e.g., Preset 4),then uses the option Touch Long to Edit. The user selects Erase andobserves if the chosen preset is erased from the Preset screen.

FIGS. 49 and 50 are views for illustrating a Treatment Preset ControlSurface “Procedures” Screen 4901. The Preset Procedures screen 4901 hasa list 4903 of patient treatment procedures that have the defaulttherapeutic parameter settings according to the fiber diameter 4902 thatthe clinician has selected. An image 4904 may indicate that a video orphoto tutorial is available for assistance on the correspondingprocedure. Examples are shown below, according to the fiber diameter andthe therapeutic parameter settings:

300 Micron 360 Micron 400 Micron Fiber Preset Fiber Preset Fiber PresetProcedures Procedures Procedures LANAP Ablation LANAP Ablation LANAPAblation 100 μsec, 100 μsec, 100 μsec, 180 mJ, 20 Hz 120 mJ, 20 Hz 220mJ, 20 Hz Abscess LANAP Hemostasis LANAP Hemostasis 150 μsec, 550 μsec,550 μsec, 110 mJ, 20 Hz 180 mJ, 20 Hz 220 mJ, 20 Hz Aphthous UlcersAbscess Abscess 150 μsec, 150 μsec, 150 μsec, 100 mJ, 20 Hz 160 mJ, 20Hz 200 mJ, 20 Hz Biopsy Incisional Aphthous Ulcers Aphthous Ulcers 100μsec, 150 μsec, 150 μsec, 30 mJ, 100 Hz 160 mJ, 20 Hz 200 mJ, 20 HzCaries Removal Biopsy Incisional Dentin Etch 100 μsec, 100 μsec, 100μsec, 210 mJ, 10 Hz 40 mJ, 100 Hz 250 mJ, 10 Hz Crown Lengthening CariesRemoval Hemostasis 150 μsec, 100 μsec, 550 μsec, 40 mJ, 50 Hz 300 mJ, 10Hz 220 mJ, 20 Hz Dentin Etch Crown Lengthening Hygiene Curettage 100μsec, 150 μsec, 150 μsec, 170 mJ, 10 Hz 60 mJ, 50 Hz 120 mJ, 20 Hz DiodeSetting Dentin Etch RCT Sterilization 100 μsec, 100 μsec, 100 μsec, 30mJ, 100 Hz 250 mJ, 10 Hz 180 mJ, 15 Hz Fibroma Diode Setting SulcularDebridement 100 μsec, 100 μsec, 150 μsec, 30 mJ, 100 Hz 40 mJ, 100 Hz180 mJ, 20 Hz Frenectomy Fibroma 100 μsec, 100 μsec, 30 mJ, 100 Hz 40mJ, 100 Hz Gingivectomy Frenectomy 100 μsec, 100 μsec, 120 mJ, 20 Hz 40mJ, 100 Hz Hygiene Curettage Gingivectomy 150 μsec, 100 μsec, 60 mJ, 20Hz 180 mJ, 20 Hz RCT Sterilization Hemostasis 100 μsec, 550 μsec, 100mJ, 15 Hz 180 mJ, 20 Hz Sulcular Debridement Hygiene Curettage 150 μsec,150 μsec, 100 mJ, 20 Hz 100 mJ, 20 Hz Tissue Recontouring RCTSterilization 100 μsec, 100 μsec, 80 mJ, 50 Hz 150 mJ, 15 Hz TroughingSulcular Debridement 250 μsec, 150 μsec, 120 mJ, 20 Hz 150 mJ, 20 HzTissue Recontouring 100 μsec, 110 mJ, 50 Hz Troughing 250 μsec, 180 mJ,20 Hz

FIG. 50 illustrates a control surface 5001 after selection, including anindication 5002 of the selected fiber diameter, and an indication 5003of the selected procedure.

FIG. 51 illustrates an example Patients Control Surface 5101, which canbe accessed by, e.g., clicking on “PATIENTS” icon 5106, and which mayinclude two separate tabs: Patients and Reporting, as can be seen fromthe Patients tab (to the left of the screen) and the Reporting tab (tothe right of the screen). As shown in FIG. 51, the “Patients” tab hasbeen selected.

The Patients tab includes a Find Patients/Alphabetical Search Icon Bar5102, where the user is able to find a patient by typing in thePatient's or Patients' name(s). The user is also given a control 5103 toselect to add a new patient. An alphabet bar 5107 includes searchfunctionality by which when the user presses on a particular letter ofthe alphabet bar (for example the letter A), then the patient names thatare listed in list 5104 that have an A at the beginning of the first orlast name (e.g., patient 5105) will be displayed.

In one example, if the user makes a mistake while entering patient dataand has already chosen the option to press save, there is a way todelete or edit the entry. Once the user has found the patient entry thathe/she would like to edit or delete, the user must long press on it forabout 2-3 seconds and a box will appear with three different options:edit, delete, and select. When edit is selected, the user is able tomake the appropriate changes. If the user selects delete then the entrywill be deleted from the list. If the user chooses the option to select,then this will have the patient name show up on the drop-down list ofthe home screen.

If the user instead selects the “Reporting” tab from, e.g., PatientsControl Surface 5101 in FIG. 51, a different series of displays may begenerated, as explained with reference to FIGS. 52 to 59.

In that regard, the eGUI records comprehensive treatment information.Each time the footswitch 314 is activated (pressed), the main laser isfired and the date and time of the activation is recorded. In addition,there is recording of the Patient name, Quadrant/Sextant and ortooth/teeth selected, the diameter of the optical fiber in use, and thefundamental therapeutic parameters: μsec, mJ, and Hz. When thefootswitch 314 is released, this data is recorded into the database foruse and analysis on the Reporting Tab of the Patient control surface.The footswitch interval is the period between activation (when thefootswitch is depressed) and release (when the footswitch is inactive).The totals of Joules and Laser Pulse “Shots” during the footswitchinterval are also recorded and appended to the data elementcorresponding to the current treatment.

To generate a report, a user may select a report filter from thereporting control surface tab 5201, which is displayed when, e.g., theuser selects the “Reporting” tab. As can be seen from FIG. 52, thereporting control surface tab 5201 has 4 main filters for the user tofind patient data: Treatment Interval 5202, Chronological 5203, FilterPatients 5204, and Filter Site 5205. Each of these filters will bedescribed in detail.

FIG. 53 illustrates a control surface 5301 for Filter 1, “TreatmentInterval”, which is essentially the date and time interval for thesystem data that one desires to examine. A window 5302 includes controls5303 and 5304 for selecting the top date as the beginning date and thebottom date as the ending date for the treatment interval filter. Theuser selects Ok with icon 5305, and the treatment data is reported tothe Reporting tab.

FIG. 54 illustrates a control surface 5401 for Filter 2, the“Chronological” tab. This tab provides several further filtering optionsvia a “Select Report Options” control display 5402: Clinician option(s)displayed as element 5403 with the choice of Self or All, groupingoptions displayed as element 5404 with selections such as: None,Patient/chronological, and Patient Tx Site (Patient Treatment Site), andreport detail options displayed as element 5405 with selections such as:Detail, Summary, or Both, along with an Ok button 5406 to confirm theselections made.

In more detail, insofar as clinician options, when the clinician choosesthe filter option Self, then the patient data for the present login useris displayed. For example, when the clinician typed in the username mdtduring the LOGIN procedure, then all the patient data for the mdt LOGINcredentials will appear on the Reporting Control Surface Screen. Whenthe user chooses the filter option All, then all the patient data withall the LOGIN credentials (username(s) and password(s)) within thedatabase will appear on the reporting control surface. This is useful ingroup practices where patients may be shared among clinicians.

Insofar as chronological grouping options, when the clinician chooses tofilter the patient data by selecting the chronological grouping optionNone, this does not filter the patient data in any particular way. Whenthe clinician chooses to filter the patient data by selecting thePt:Chron grouping option, the patient data will appear alphabetically onthe reporting control surface and then each record is sequenced by dateand time. When the clinician chooses to filter the patient data byselecting the chronological grouping option Pt:Tx Site, then the patientdata will appear by Patient Name, then by the treatment site, andfinally by date and time within the treatment site.

Insofar as report detail options, option “Summary” shows joules andshots only, option “Detail” shows all recorded therapeutic parameterswithin each footswitch activation interval, and option “Both” providesfor the report detail option, and cumulative summaries of the patientdata.

FIG. 55 illustrates a control surface 5501 for Filter 3, “FilterPatients”. When selected, this filter displays a list 5502 includingeach of the names found in the database for the time interval selectedusing Filter 1. The user selects/checks a patient name or severalpatient names. To compare the selection of the patient names the usermay press the Ok button 5503. The data only for those selected patientswill appear on the reporting control tab. If there are no patient namesto select from on the drop-down list of this filter then data for“undefined” which means no specific patient will be displayed after theuser selects Ok. This means that no patient names were selected prior tothe footswitch activation within the Filter 1 time interval. The defaultcondition is all patient names.

FIG. 56 illustrates a control surface 5601 for Filter 4, the “filtersite” option. When selected there is a drop-down list 5602 titled SelectQuadrants or Sextants. The drop-down list 5602 pertains to theclinicians' selection(s) of the Dental Arch options, whether Quadrant(s)or Sextant(s), which appear on the home screen. When the clinicianselects one of the different filter sites (e.g., UR, UL and LR) for theclinician to be able to view the patient data, the patient data forthose selected filter sites appears on the reporting control tab. Thedefault condition is that all Quadrants/Sextants are displayed. Thedrop-down list also includes an Ok button 5603 for confirmingselections.

In one embodiment, a deliberate long touch on either of the drop-downlists of Filters 3 and 4 will activate a pop-up screen 5701 as shown inFIG. 57, with selections to Select All, Deselect All, or Cancel.

FIG. 58 is a view for illustrating a refresh button 5802 located towardthe upper right side of the Reporting tab 5801 and, when selected, hasthe functionality of showing patient data.

In FIG. 59, a control surface 5901 includes a print icon 5902: The printicon 5902 is configured with the main laser computer 300, tablet 400(including, e.g., a tablet Bluetooth printing app), and a correspondingprinter to print out patient data that appears on the reporting tab orthe reporting control surface 5901. The printer icon 5902 is locatedtoward the bottom right side of the home screen. This enables the userto be able to print out screen shots from the home screen as well asdata from the Info/Timer icon bar and the 3 different options offeatures that can be accessed.

In one example, to use Bluetooth to print out patient data that isdisplayed on the Reporting tab (reporting control surface), the userselects the printer icon 5902 which is located toward the lower rightside of the screen. Once the user has selected the printer icon 5902 onthe reporting control surface (e.g., surface 5901), then the user willbe brought to, e.g., a print mobile app screen, by which the user mayselect nearby Bluetooth printers. Once selected the print mobile appwill do a device scan searching for Bluetooth printers, and select acorresponding print icon so that the selected patient data will beprinted out.

A sample report actually printed from the eGUI and the Bluetooth Printermight be arranged as follows:

Treatment Interval 2012 Aug. 6 09:11:00 to 2014 Aug. 6 10:37:36Patient - Both Patient Name (Last, First) Date Time Secs Clinician SiteJoules Shots Dose μS mJ Hz dia Proc Name Yves, Yolonda 08-06 10:24 17.0Boot LR 102.6 342 — 100 300  20 360 Undefined Camp Yves, Yolonda 08-0610:24 14.0 Boot LR 85.5 285 — 100 300  20 360 Undefined Camp Yves,Yolonda 08-06 10:23 8.0 Boot LL 43.2 144 — 100 300  20 360 UndefinedCamp Yves, Yolonda 08-06 10:23 4.0 Boot 4i 23.1 77 — 100 300  20 360Undefined Camp Yves, Yolonda 08-06 10:23 11.0 Boot 4i 67.5 225 — 100 300 20 360 Undefined Camp Yves, Yolonda 08-06 10:22 12.0 Boot 4 66.3 221 —100 300  20 360 Undefined Camp Yves, Yolonda 08-06 10:22 5.0 Boot UR35.1 117 — 100 300  20 360 Undefined Camp Yves, Yolonda 08-06 10:22 0.0Boot UR 0.3 1 — 100 300  20 360 Undefined Camp Yves, Yolonda Total 423.61412 Oblanc, Othello 08-06 09:35 0.0 Boot LL 0.7 17 100 100  40 100 360Undefined Camp Oblanc, Othello 08-06 09:35 1.0 Boot LL 4.3 108 100 100 40 100 360 Undefined Camp Oblanc, Othello 08-06 09:35 0.0 Boot LL 1.024 — 100  40 100 360 Undefined Camp Oblanc, Othello 08-06 09:33 4.0 Boot20c 20.4 511 — 100  40 100 360 Undefined Camp Oblanc, Othello 08-0609:32 6.0 Boot 20 22.5 562 — 100  40 100 360 Undefined Camp Oblanc,Othello 08-06 09:32 7.0 Boot 31c 30.0 751 110 100  40 100 360 UndefinedCamp Oblanc, Othello 08-06 09:31 10.0 Boot LR 38.2 955 110 100  40 100360 Undefined Camp Oblanc, Othello 08-06 09:31 15.0 Boot LR 59.2 1480110 100  40 100 360 Undefined Camp Oblanc, Othello 08-06 09:30 6.0 BootLR 25.2 631 110 100  40 100 360 Undefined Camp Oblanc, Othello Total201.6 5039

FIGS. 60 to 65 are views for explaining administration control screensaccording to example embodiments.

In one example, a main laser computer 300 “Admin” screen might include 2separate tabs: a Measure Power tab and the Control Panel tab.

FIG. 60 depicts an example control screen 6001 in accordance with theMeasure Power tab 6002. The Measure Power tab 6002 has the samefunctionality as the P_(M) (power measurement) mode under the Energyicon bar on the Home screen. This measures power output. The useradjusts the therapeutic parameter settings by clicking on μsec 6003, mJ6004, and Hz 6005, then selecting the up and down arrows or clicking onthe therapeutic parameter itself; a drop-down list of settings willappear. Therapeutic parameter settings that appear on the 3-columnpop-up box of the Energy pop-up box (shown previously) with a red lockedicon indicating that those set of therapeutic parameter settings cannotbe changed. Control screen 6001 also includes an indicator 6006 that thelaser is in standby mode, Auto Power Measure icon 6007 allowing forselection of the automatic power measure mode, and information display6008 indicating the set power.

FIG. 61 is an example of a control screen 6101 displayed in accordancewith the control panel tab. Control screen 6101 includes a control 6102for selecting aiming beam intensity, with a default preferred setting of5. Control screen 6103 also includes a time zone setting control 6103.In that regard, selection of the time zone setting control 6103 maycause a display of a pop-up list of selectable time zones, as shown inFIG. 62. In particular, as shown in FIG. 62, a control screen 6201includes the displayed list 6202. The local time zone feature has adrop-down list of countries, cities and states that the user can choosefrom so that the time on the tablet will coincide with the user's localtime zone.

Returning to FIG. 61, a selectable icon 6104 may also allow a user toset the local date and time.

Start-up Configuration Checkbox Options 6105, 6106 and 6107 are featuresthat can be accessed through the home screen of the tablet 400 when theyare selected (checked). In particular, the options include option 6105for Energy Parameter INFO Display By Default. When the user selects thischeck box, the Joules and Shots will appear by default on the homescreen underneath the Timer/Info icon bar. Option 6106 for Dental ArchSextant Mode provides that when the user selects this check box, thedental arch that will appear by default on the home screen will be theSextant dental arch. Option 6107 for clear Joules/Shots on ToothSelection provides that when the user selects this check box, the mJ onthe home screen will clear to zero automatically when the user isaccessing the Individual Tooth selection then decides to opt out of thisfeature on the home screen.

Screen Brightness control 6108 allows the user to control the screenbrightness of the tablet by swiping from left to right. Restore DefaultTherapeutic Parameters control 6109, when selected, restores the defaultsetting of the therapeutic parameter settings on any previouslyoverwritten preset procedures.

Information display 6110 includes, e.g., a software and firmware versionfor main laser computer 300. This informs the user of what software ofthe tablet 400 is running and firmware version that the main lasercomputer 300 has installed. In this embodiment, the user should be ableto read that the most up-to-date versions are: Software Main lasercomputer 300 MVP-7 v1.09b and Firmware 1.0.8. If these versions are notup-to-date then the user can have the latest versions installed toensure the eGUI interface can be utilized with all the current featuresfor an enjoyable user experience.

FIGS. 63 to 65 are views for explaining service mode screens.

FIG. 63 is a view of a control screen 6301 for selecting a service mode.In one embodiment, Service Mode is a feature that should be onlyaccessible by a technician, rather than a clinician. This allows theuser to have access to 4 separate TABS: Measure Power, Control Panel,and Service Mode tab 6302, which, when selected, displays buttons 6303and 6304 for selection of service modes 1 and 2, respectively. In oneexample, in order to access the service mode feature, the user mustlogin with service mode login credentials which are, e.g., “service”(all lowercase) for both username and password.

In that regard, the functionality of the measure power tab under theservice mode credentials may have the same functionality as that of theMeasure Power tab on the main laser computer 300 ADMIN Screen(s), andthe functionality of the control panel tab under the service credentialsmay have the same functionality as that of the Measure Power tab on themain laser computer 300 ADMIN Screen(s).

FIG. 64 illustrates an example control screen 6401 when the SERVICE MODE1 icon bar (6402) is selected. In one example, to access the servicemode 1, the user selects a Service Modes tab from the Main lasercomputer 300 ADMIN screen. Once the Service Modes tab is selected, theuser presses the SERVICE MODE 1 icon bar 6402 to be brought to theService Mode 1 screen 6401. Service mode 1 allows operation of the laserat fixed current and pulse width, while monitoring the internal energymonitor. To adjust the μsec, Amps, and Hz settings, the user selects thecorresponding parameter icon bars (6403, 6404 and 6405, respectively)and a drop-down list (not shown) will appear, after which the user maychange the settings by using the (+) and (−) buttons or by selecting onthe parameter itself and swiping up and down to select the desiredindividual parameter(s), after which a “SET” selection may save theparameters. The calibration factor can be changed with an icon bar 6406,to match the laser output to an external power meter, and saved with anicon bar 6407. To change the calibration factor (cal factor), the usersimply selects the Cal Factor icon bar 6406 and a drop-down list willappear. The user may swipe up and down to select a desired selectionthen press the Save Cal Factor icon bar 6407 to save the changes.Information display 6408 displays the measured power from the internalenergy monitor, averaged over, e.g., 10 pulses. The footswitch fires thelaser at the selected current, repetition rate and pulse width. Thecoolant pump will run, the READY lamp will light, and the aiming beamwill turn on.

FIG. 65 illustrates an example control screen 6501 when the SERVICE MODE2 icon bar (6502) is selected. In one example, to access the servicemode 2, the user selects a Service Modes tab from the Main lasercomputer 300 ADMIN screen. Once the Service Modes tab is selected, theuser presses the SERVICE MODE 2 icon bar 6502 to be brought to theservice mode 2 screen 6501. Service mode 2 allows control of the HVPSsupply using area 6503. Service mode 2 also allows testing of thecapacitor charge (Cap Charge) and/or simmer circuits using controls 6504and 6505, display of the coolant temperature 6506 and setting of thetube start current with control 6507. Service Mode 2 sets the tube startcurrent and the default setting for this 15. The coolant pump will run.

During a charge and simmer test, a warning may be displayed as follows:

WARNING: High voltages are present when performing this service with thecover off. Do not touch any wiring or components until power isdisconnected and you are sure all capacitors have discharged.

Meanwhile, the measured coolant temperature may be shown in the timerdisplay, in degrees C., for the user to confirm that the thermistorsense circuitry is functioning.

FIGS. 66 and 67 are views for explaining an example of users andprocedures Database Administration. In particular, FIGS. 66 and 67 areviews for using an SQL Lite database administrator console to manageusers, user rights, procedures and images.

In that regard, FIG. 66 depicts an example of a first administrationscreen 6601. In this example, an administrator has selected a “fields”folder 6607 from a set of “users” on the left side, and selected an“Edit Data” tab 6606 on the right side. Drop-down list 6605 allows fordisplay of other tables, but is currently set on “users”. The editableusers table includes column 6602 for a user id, column 6603 for ausername, and column 6604 for a corresponding user password.

FIG. 67 depicts an example of another administration screen 6801,including detailed fields for a procedures table, including a column forprocedure id 6802, a column for user id 6803, a column for a valueindicating a level of access 6804, as discussed above, a column 6805 forprocedure name, a column 6806 for a procedure image (if applicable oravailable), column 6807 for a pulse width corresponding to theprocedure, column 6808 for an energy value corresponding to theprocedure, column 6809 for a repetition rate corresponding to theprocedure, and a column 6810 indicating the fiber diameter correspondingto each procedure id.

Treating Gingival Disease

Aspects of the method for treating gingival disease will now beillustrated and described with respect to FIGS. 68 to 70.

In that regard, FIG. 68 is a section of a gingival tissue prior to theadministration of a LANAP® procedure according to an example embodiment.FIG. 69 is a section of the same gingival tissue as in FIG. 68 showingthe position of surgical tissue severing according to an exampleembodiment, and FIG. 70 is a section of the same gingival tissue as inFIG. 68 after completion of a LANAP® procedure according to an exampleembodiment.

Referring now to FIGS. 68 to 70, the LANAP® Procedure comprises astep-by-step approach. First, the gingival tissue 5 corresponding to atargeted tooth and root 10 is anesthetized. The depth of a pocket 20 inthe gingival tissue is measured, preferably with a periodontal probe 30,taking at least six spaced-apart measurements around the tooth root 10.The pocket depth is defined as extending from the upper gingival margin40 to the mucogingival junction 50. The interior epithelial lining 60 ofthe pocket 20 is then ablated and vaporized to the full depth of thepocket 20, preferably using a laser fiber having a preferred diameter ofbetween 100 microns and 600 microns, the fiber preferably orientedparallel to the surface of the tooth root 10. This is completed on allsides of the tooth 10. This step generates and prepares a new pockettissue surface 70. Preferably not more than 10 Watts of fiber outputpower is used, as measured at the distal end of the fiber, and a lasingfrequency of not more than 100 hertz is preferably applied. Pulseduration range in this example may be 100 to 650 microseconds.

Next, the surface of the tooth and root 10A is cleaned of all foreignmatter 10B, again (using, e.g., an ultrasonic handpiece as describedabove), to the depth of the pocket 20 on all sides of the tooth and root10. In this example, this is followed by an irrigation of the pocket 20with a bactericidal solution. Following that, the pocket 10 is lased toremove granulomatous tissue, and to disinfect, assist in hemostasis,cauterize free nerve endings, and seal lymphatics of the pocket tissuesurface. Lasing also prepares the pocket tissue surface 70 for adhesionto the tooth and root surface.

Next, occlusal interferences and occlusal traumatic forces areeliminated (using, e.g., a high-speed handpiece). The new pocket tissuesurface 70 is lased to adapt it for clot and tissue adhesion. The pockettissue surface 70 is approximated with the tooth and root surface 10Apreferably with finger pressure to hold the pocket tissue surface 70 incontact with the tooth and root surface 10A, preferably from 2 to 3minutes, allowing a thin clot 80 to form between the pocket tissuesurface 70 and the tooth and root surface 10A so as to advance andassure adhesion of these tissues. Finally, the body's natural immunesystem is enhanced by prescribed medications for outpatient use inpreventing infection. This step is useful in order to protect againstinfection and reduce inflammation. The procedure preferably includes thefurther step of providing at least one subsequent occlusal equilibrationexamination.

Further example aspects of one embodiment of an example procedure arenow described. In one example, the area of concern, usually twoquadrants, is anesthetized. The procedure is applied independently toeach tooth involved. Pocket depth is measured and recorded with a perioprobe to determine the full depth of the diseased pocket. A contactlaser fiber is oriented along the long axis of the tooth root, and isused to create a gingival trough or flap by ablating the free gingivalmargin and the internal epithelial lining of the pocket, therebyexposing the tooth root surface. Appropriately cleaved contact laserfibers provide precise control of the laser energy, the physicalplacement of the laser energy, and the determination of the desiredphysical orientation of the laser to the tissue to be removed. Agingival trough or flap is used to expose the tooth root surface.Excision of the free gingival margin removes pathogens and pathologicproteins within the tissue of the free margin which are otherwiseunremovable, and provides hemostasis for better visualization. This stepalso defines the tissue margins preceding mechanical instrumentation,and preserves the integrity of the mucosa. It also dissects-out theseparation between the free gingival margin and the fibrous collagenmatrix which holds the gingiva in position. This aids in the maintenanceof the crest of the gingival margin. With the use of the “hot-tip”effect, further excision of the inner pocket epithelium around theentire tooth and root is completed, to the depth of the probe readings.Ordinarily, no attempt is made to break through the mucogingivaljunction with the optical fiber. The “hot-tip” effect (accumulatedtissue proteins heated via conductivity secondary to the passage oflaser energy through the fiber) provides the selective removal ofsulcular and pocket epithelium and granulomatous tissue without removingsubstantially any connective fibrous tissue, and does socircumferentially and radially. As necessary, the excised tissue thataccumulates on the tip of the laser fiber is removed. Ultrasonic scalingof all tooth and root surfaces to the depth of pocket is completed. Theintent is to remove all foreign structures and substance from the pocketto allow adhesion of the soft tissue to the clean tooth and rootsurface. Lasing of the pocket to remove remaining granulomatous tissue,disinfect tissue, assist in hemostasis, cauterize free nerve endings,seal lymphatics, prepare tissue for soft and fibrin clot adhesion totooth and root surface is accomplished. Elimination of occlusalinterferences and occlusal traumatic forces is completed using, e.g., ahigh-speed handpiece as described herein. For best results this step ishelpful, since it allows the tissue to heal and the bone to regenerate.The laser modifies the tissue to allow new attachment to take place butif the trauma of malocclusion continues the tissue cannot withstand andbegins to break down immediately. All treatment sites are irrigated tothe deepest depth of the periodontal pockets with a bactericidalsolution of a high tissue substantivity (e.g., chlorhexidine gluconate0.12%). The irrigation aids the laser in the reduction of bacteria inthe pocket and in removing debris. Approximation of the wound edges iscompleted. Lasing is further accomplished to control blood flow asneeded. Healing of the wound edges is by secondary intention. The tissueis compressed with finger pressure for 1 to 3 minutes against the toothand root from both a facial and lingual direction in order to permitonly a thin clot to form between the tissue and the tooth and root.

Post-procedural steps include prescribing medications for home use andreviewing postoperative care with the patient. An anterior deprogrammerand dis-occluding occlusal splint may be used to provide anteriorguidance, e.g., a “LANAP Splint” or anterior “jig”. A thorough occlusaladjustment follow-up examination is required. This treatment shouldcontinue periodically until bone development is complete. Pocket-depthmeasurements are to be avoided for 12 months.

In another example embodiment, a laser-assisted gingivitis and completeperiodontitis bone, periodontal ligament and cementum tissue complextrue regeneration procedure uses a free-running pulsed neodymium yttriumaluminum garnet laser device with a 1,064-nanometer wavelength and dutycycles between 0.10 and 1.95 percent (100 to 650 microseconds at 10 to30 hertz), average powers between 2.4 Watts and 6.0 Watts, energy levelsbetween 80 millijoules and 600 millijoules, peak powers between 123Watts/pulse and 6000 Watts/pulse, energy densities between 64 J/cm² and849 J/cm², power densities between 1910 Watts/cm² and 8488 Watts/cm²using preferably the free-running pulsed Nd:YAG PerioLase® MVP-7™ andincludes steps of anesthetizing soft and hard tissues corresponding to atargeted tooth, quadrant or sextant of teeth of a patient, the toothhaving a root and root surface, bone sounding using a periodontal probeand recording the depths of all bony defects in the soft tissue at 6sites around the targeted tooth and root and to bone, from an uppergingival margin to the extent of the accessible bony defect, recordingthe sum total of all 6 probe depths/bone soundings and multiplying by apredesignated constant which in this example is 1 to 40, depending onsoft tissue phenotype (biotype), LANAP® Periodontal Disease Case TypeClassification I-V, and LANAP® Tooth Mobility Score 0-4 (representing a“light dose” of 1 to 40 Joules per millimeter pocket depth. Example: 6probe depths of 10 mm each=60 mm total×1=60 Joules of total light dose).The total light dose is applied such that the majority of the totallight dose is applied during the LANAP® Ablation, while the remainingportion of the total light dose is delivered during the LANAP®Hemostasis setting. In this example, the total light dose is applied⅔rds during the LANAP® Ablation, while the remaining ⅓rd of the energyis delivered during the LANAP® Hemostasis setting. In this example, 40Joules are delivered during the LANAP® Ablation Step, and 20 Joules aredelivered during the LANAP® Hemostasis Step. The example further uses aFiberFlex™ 300-, 320-, 360-, 400-micron (preferably a 360-micron)diameter quartz optical fiber fed through an anodized aluminum TrueFlex®handpiece and bendable cannula, photothermally rupturing,disassociating, separating, ablating, denaturing and vaporizing theinner diseased, inflamed, infected, bacteria-invaded, ulceratedepithelial lining of the pocket and granulomatous tissues,photothermally altering, disrupting, denaturing, dehydrating, anddestroying hard calcified calculus and concrements on the tooth and rootsurface, to the soft tissue and hard tissue extent of the pocket andfull bony defect, on all sides of the tooth and root to prepare the rootsurface of said tooth for a complete new regenerative tissue complexconsisting of new alveolar bone, periodontal ligament and cementum, orlong junctional epithelium, and includes lasing the tooth and rootsurface to destroy lipopolysaccharides (LPS) of gram-negative bacteria,irradiating tissue with blue light with energy densities between, butnot limited to, 1 and 2500 J/cm² and power densities between, but notlimited to, 10 to 1200 mW/cm² for lethal effect on bacteria, using alaser and/or preferentially LANAP® PiezoSonic piezo-electric ultrasonicdevice with water lavage and 20,000 to 30,000 hertz, and specializedLANAP Piezo ultrasonic tips, operating at 8 to 10 Watts, used insequence for cleaning the tooth and root surface of all foreign matter,bacterial smear layer covering and included in soft and hardcalcification, calculus, concrements, cement on the tooth and rootsurface to the full depth of the pocket on all sides of the tooth androot surfaces from crestal margin to bony defect base, decorticating thecrestal and marginal ridge bone to perform an osteotomy and/or ostectomyand to initiate angiogenesis, irrigating the pocket with a bactericidalsolution, preferably chlorhexidine 0.12%, and using the laser within thefull parameter range. In this example embodiment, the laser is used withaverage powers of 2.4 to 6.0 Watts, 10 to 30 hertz repetition rate, and100 to 650 microsecond pulse duration, preferably with Duty Cyclesbetween 0.1 percent and 1.95 percent. At 100 microsecond pulse duration(in this example): Average Power of 2.4 Watts, Energy Level of 120millijoules, Peak Power of 1200 Watts/pulse, Energy Density of 118J/cm², Power Density of 2358 Watts/cm² and Duty Cycle of 0.20 percent;to an Average Power of 6.0 Watts, Energy Level of 300 millijoules, PeakPower of 3000 Watts/pulse, Energy Density of 295 J/cm², Power Density of5894 Watts/cm² and Duty Cycle of 0.2 percent; to 650 microsecond pulseduration: Average Power of 2.4 Watts, Energy Level of 120 millijoules,Peak Power of 184 Watts/pulse, Energy Density of 118 J/cm², PowerDensity of 2358 Watts/cm² and Duty Cycle of 1.0 percent; to an AveragePower of 6.0 Watts, Energy Level of 300 millijoules, Peak Power of 461Watts/pulse, Energy Density of 295 J/cm², Power Density of 5894Watts/cm² and Duty Cycle of 1.0 percent.

In one aspect, the procedure further includes using a FiberFlex™ 300-,320-, 360-, 400-micron (preferably a 360-micron) diameter quartz opticalfiber fed through an anodized aluminum TrueFlex® handpiece and bendablecannula; lasing to intentionally irradiate the bone at the base of thebony defect in the 6 separate pocket depth measurement locations toinitiate hemostasis from the medullary bone; stimulate and upregulatethe release of growth factors (e.g., IGF-1 and IGF-II, TGF-beta 1,TGF-beta 2, BMP-2); stimulate and upregulate fibroblasts and stem cells;warm the blood in the pocket to thermolytically cleave fibrinogenthereby converting the blood into fibrin (thrombin catalyzes theconversion of fibrinogen to fibrin), create a stable fibrin clot, andcreate angiogenesis; remove and/or denature any remaining, residualgranulomatous tissue and inflamed, infected and diseased epitheliallining, intentionally leaving granulation tissue in place (inclusive ofstem cells, capillaries, fibroblasts), but disinfected; disinfect,assist in hemostasis, cauterize free nerve endings, and seal lymphaticsof the pocket tissue surface; and prepare the pocket tissue surface foradhesion; lasing the pocket tissue surface to adapt the pocket tissuesurface for tissue adhesion; approximating the pocket tissue surfacewith the tooth and root surface; maintaining the pocket tissue surfacein contact with the tooth and root surface to advance adhesion; andeliminating occlusal interferences and occlusal traumatic forces. In oneaspect, the depth measuring is completed with a periodontal probe takingat least six spaced-apart measurements around the tooth root. In anotheraspect, the ablating, vaporizing, and lasing are completed with a laserfiber oriented parallel to the surface of the tooth root. In stillanother aspect, the procedure includes a step of providing afree-running pulsed Nd:YAG, 1,064-nanometer wavelength laser, preferablythe PerioLase® MVP-7™, wherein the ablating, denaturing and vaporizingis completed with not more than 6.00 Watts of average output power fromthe laser, as measured at the distal end of the fiber, and with a lasingfrequency of not more than 100 Hz. In yet another aspect, the laserfiber is of a diameter between approximately 200 and 600 microns. Instill another aspect, the method includes firm pressure to hold thepocket tissue surface in contact with the tooth and root surface for 1to 3 minutes allowing a thin clot to form between the pocket tissuesurface and the tooth and root surface.

In these examples, the TrueFlex® handpiece is fabricated from anodizedaluminum, but in other examples the handpiece may be fabricated fromstainless steel, plastic, Delrin®, titanium and so forth, and notnecessarily anodized aluminum.

It should be understood that the body's natural immune system isenhanced by prescribed medications for outpatient use in helping toprevent infection. This step may be important or necessary in order toprotect against infection and reduce inflammation. The procedurepreferably includes the further step of providing at least onesubsequent occlusal equilibration examination.

II. LENAP+eGUI

According to another embodiment herein, a method for removing deepgingival pockets, e.g., a laser excisional new attachmentprocedure/protocol (LENAP), provides for excise of disease whileproviding for reconnection of the tissue-tooth connection. Steps in theprocess include creating a gingival trough in the pocket with a contactlaser fiber, excising the pocket epithelium while selectively removingsulcular and pocket epithelium and granulation tissue fully around thetargeted tooth to the full depth without breaking through themucogingival junction, scaling the root surfaces to the full depthultrasonically, lasing the pocket to remove granulation tissue and todisinfect the tissue, assist in hemostatis, cauterize free nerveendings, seal lymphatics, prepare the tissue for welding and desensitizethe tooth, and compressing the tissue against the tooth until adhesionis achieved.

The eGUI can assist the clinician in performing the laser delivery stepsof the LENAP protocol by providing procedure presets consistent with thelevel of clinician training proficiency and certification, as describedabove with respect to, e.g., FIGS. 4, 7, 48, 49, 66 and 67.

The eGUI also assists the clinician in performing the laser deliverysteps of the LENAP protocol by providing instructional and patienteducational videos and photos, as described above with respect to, e.g.,FIGS. 14, 49 and 50.

The eGUI further assists the clinician in performing the laser deliverysteps of the LENAP protocol by providing use of individually selectablePulse Duration, Energy, Repetition Rate, and intuitive Average Powergroupings within a safe therapeutic treatment window, as described abovewith respect to, e.g., FIGS. 3, 4, 16 to 26, 38, 47, 48, 60 and 61.

The eGUI additionally assists the clinician in performing the laserdelivery steps of the LENAP protocol by providing display of measuredpower contrasted with average power settings to help ensure deliveredpower matches the intended amount, as described above with respect to,e.g., FIGS. 30 to 39.

The eGUI further assists the clinician in performing the laser deliverysteps of the LENAP protocol by providing the ability to hold averagepower constant as repetition rate or energy settings are individuallyadjusted, as described above with respect to, e.g., FIGS. 27 to 29.

The eGUI also assists the clinician in performing the laser deliverysteps of the LENAP protocol by communicating with a smart connector thatidentifies the diameter of the optical energy delivery system (e.g., adiameter of fiber 502) in order to adjust laser parameters accordingly,as described above with respect to, e.g., FIGS. 3, 13, 14, 16, 21, 38,49, 50 and 67.

The eGUI additionally assists the clinician in performing the laserdelivery steps of the LENAP protocol by providing ability to hold energydensity constant when optical fiber diameters are changed, as describedabove with respect to, e.g., FIGS. 3, 13, 14, 16, 21, 38, 39, 49, 50 and67.

The eGUI also assists the clinician in performing the laser deliverysteps of the LENAP protocol by providing a display of Joules, Shots,Energy Density, Power Density and Peak Power settings to determine laserbeam intensity, impact, and overall effect on tissue, as described abovewith respect to, e.g., FIGS. 3, 4, 13 to 39, 43, 50, 52, 54, 60, 61 and67.

The eGUI further assists the clinician in performing the laser deliverysteps of the LENAP protocol by providing synchronization with electronicrecords plus tissue phenotype exemplar photographs to aid in accuraterecording, saving and computing parameters and light dose, as describedabove with respect to, e.g., FIGS. 4, 11, 14, 30 to 33 and 49 to 59.

The eGUI also assists the clinician in performing the laser deliverysteps of the LENAP protocol by providing a presentation of light dose tothe clinician for approval or adjustment, as described above withrespect to, e.g., FIGS. 4, 30 to 33 and 39.

The eGUI additionally assists the clinician in performing the laserdelivery steps of the LENAP protocol by providing conversion of averageprobe depth diagnostics into J/mm average pocket depth and then to lightdose, as described above with respect to, e.g., FIGS. 7 and 30.

The eGUI further assists the clinician in performing the laser deliverysteps of the LENAP protocol by providing an intuitive chart display ofenergy delivery progression of photobiomodulation and LENAP light dosedelivery that is visually tracked with reference bands corresponding todosage for first and second pass and managed with a countdown timeraccording to energy delivery rates and thermal-relaxation criteria, andfollowing the LENAP protocol formula for the first and second laserpass, as described above with respect to, e.g., FIGS. 36 to 39.

In that regard, each of the foregoing features provided by the eGUIpromote safety, effectiveness and efficiency of the LENAP protocol forthe benefit of the patient.

For purposes of efficiency in description of the LENAP protocol herein,reference may be made again to FIGS. 68 to 70.

In that regard, this embodiment relates generally to surgicalprocedures, and more particularly to an improved surgical method foreliminating a condition of deep gingival pockets and the diseaseassociated with this condition.

Specifically, periodontal diseases are caused by certain types ofbacteria in plaque. These bacteria create toxins which irritate the gumsand result in a breakdown of the attachment of the gum tissues to theteeth. Over time, these toxins can destroy gum tissues, and allowing theinfection to progress, can result in bone loss. There are many forms ofgingival and periodontal diseases, the most common types beinggingivitis and adult periodontitis. Gingivitis is the earliest stage,and affects only the gum tissue. At this stage, the disease is stillreversible. If not treated, however, it may lead to a more severecondition called periodontitis. The gums, bone and other structures thatsupport the teeth become damaged. Teeth can become loose and may have tobe removed. At this stage, the disease may require more complextreatment to prevent tooth loss. With healthy gingiva (gum tissue), theteeth are firmly anchored in place. Gingivitis develops as toxins inplaque irritate the gums, making them red, tender, swollen and likely tobleed easily. Periodontitis occurs when toxins destroy the tissues thatanchor them in the bone. Gums become detached from the teeth, formingpockets that fill with more plaque. Tooth roots are exposed to plaqueand become susceptible to decay and sensitive to cold and touch.Advanced periodontitis is present when the teeth lose more attachmentbecause the supporting bone is destroyed. Unless treated, the affectedtooth frequently become loose and may fall out. The method of treatmentof periodontal diseases depends upon the type of disease and how far thecondition has progressed. The first step is usually a thorough cleaningwhich may include scaling to remove plaque and calculus deposits beneaththe gum line. The tooth roots may also be planed to smooth the rootsurface so that the gingiva may heal next to the teeth. Surgery may berequired when deeper pockets, usually over 4 to 6 mm, are found. It isdifficult for the dentist or hygienist to thoroughly remove plaque andcalculus from deep pockets. Patients can seldom keep them clean and freeof plaque. Allowing pockets to remain may invite infection and bonedestruction. When pockets are deep and bone has been destroyed, flapsurgery may be necessary to provide access to the roots of the teeth inorder to thoroughly remove calculus, plaque and any diseased tissue, andto recontour the bone to a more favorable architecture. In thistechnique, the gum is lifted away and is then sutured back into place orinto a new position that will be easier to keep clean. Some methodsteach the use of surgical debridement of the root surface and theremoval of granulation tissue following the resection of the soft tissueflap. Aesthetic modifications of this approach have been reported underthe title of open flap curettage, reverse bevel flap surgery, Widmanflap surgery and modifications of Widman flap surgery and apicallypositioned flap osseous surgery, guided tissue regeneration.

The embodiment relates to the removal of the deep gingival pocket,elimination of disease and reattachment of the gingiva to the toothsurface.

By virtue of this embodiment, it is ordinarily possible to treatgingivitis or gum disease, and to eliminate gingival pockets byestablishing a new connective tissue attachment to the tooth at, ornear, the coronal level by producing a long junctional epithelium. Theinflamed sulcular and pocket epithelium is excised without substantiallyremoving any connective tissue. The procedure, as described, isindicated when there is a moderate-to-deep, as probed pocket depth of 5mm or greater, as measured from the coronal to the mucogingivaljunction, and when any of the following is present: bony defects visibleand/or probable, infection in the gingival tissue, mobility of thedentition, and/or aesthetic considerations.

A laser, such as provided by Millennium Dental Technologies, Inc.“PerioLase® MVP-7™” including eGUI, operating at a wavelength of, e.g.,between 400 and 12,000 nanometers (in one example, preferably 1064nanometers), is used to create an initial excisional trough at themarginal gingiva using between one and one hundred Watts, preferably2.4-6.0 Watts of fiber output power (measured at the distal end of thefiber), and frequencies between one hertz and three hundred megahertz,preferably 10-30 Hertz.

In that regard, although this procedure is described with respect to aspecific device (PerioLase® MVP-7™ including eGUI), it should beunderstood that the procedure is not limited to this device, and can beperformed by other devices capable of laser dosimetry, such as anoriginal MVP-7™ type laser without the eGUI.

In one example, the laser device has a 1,064-nanometer wavelength andoperates over a preferred parameter range which includes duty cyclesbetween 0.10 and 1.95 percent (100 to 650 microseconds at 10 to 30hertz); average powers between 2.4 Watts and 6.0 Watts; energy levelsbetween 80 millijoules and 600 millijoules; peak powers between 123Watts/pulse and 6000 Watts/pulse; energy densities between 64 J/cm² and849 J/cm²; and power densities between 1910 Watts/cm² and 8488Watts/cm².

According to the embodiment, the method includes excising the innerpocket epithelium around the entire tooth to a depth equal to an initialprobe reading of the inner pocket. The eGUI assists the clinician inperforming the laser delivery steps of the LENAP protocol by providing:procedure presets consistent with the level of clinician trainingproficiency and certification; instructional and patient educationalvideos and photos; use of individually selectable Pulse Duration,Energy, Repetition Rate, and intuitive Average Power groupings within asafe therapeutic treatment window; display of measured power contrastedwith average power settings to help ensure delivered power matches theintended amount; ability to hold average power constant as repetitionrate or energy settings are individually adjusted; a smart connectorthat identifies the diameter of the optical energy delivery system inorder to adjust laser parameters accordingly; ability to hold energydensity constant when optical fiber diameters are changed; a display ofJoules, Shots, Energy Density, Power Density and Peak Power settings todetermine laser beam intensity, impact, and overall effect on tissue;synchronization with electronic records plus tissue phenotype exemplarphotographs to aid in accurate recording, saving and computingparameters and light dose; presentation of light dose to the clinicianfor approval or adjustment; conversion of average probe depthdiagnostics into J/mm average pocket depth and then to light dose; andan intuitive chart display of energy delivery progression ofphotobiomodulation and LENAP light dose delivery that is visuallytracked with reference bands corresponding to dosage for first andsecond pass and managed with a countdown timer according to energydelivery rates and thermal-relaxation criteria, and following the LENAPprotocol formula for the first and second laser pass—all of whichpromote safety, effectiveness and efficiency of the LENAP protocol forthe benefit of the patient.

The excising is followed by an ultrasonic scaling of root surfaces androot planing and scaling of all cementum. The procedure further includescleaning steps and a lasing of the pocket in preparation for tissuewelding. The eGUI assists the clinician in these steps by providing:procedure presets consistent with the level of clinician trainingproficiency and certification; instructional and patient educationalvideos and photos; use of individually selectable Pulse Duration,Energy, Repetition Rate, and intuitive Average Power groupings within asafe therapeutic treatment window; display of measured power contrastedwith average power settings to help ensure delivered power matches theintended amount; an ability to hold average power constant as repetitionrate or energy settings are individually adjusted; a smart connectorthat identifies the diameter of the optical energy delivery system inorder to adjust laser parameters accordingly; ability to hold energydensity constant when optical fiber diameters are changed; a display ofJoules, Shots, Energy Density, Power Density and Peak Power settings todetermine laser beam intensity, impact, and overall effect on tissue;synchronization with electronic records plus tissue phenotype exemplarphotographs to aid in accurate recording, saving and computingparameters and light dose; presentation of light dose to the clinicianfor approval or adjustment; conversion of average probe depthdiagnostics into J/mm average pocket depth and then to light dose; andan intuitive chart display of energy delivery progression ofphotobiomodulation and LENAP light dose delivery that is visuallytracked with reference bands corresponding to dosage for first andsecond pass and managed with a countdown timer according to energydelivery rates and thermal-relaxation criteria, and following the LENAPprotocol formula for the first and second laser pass—all of whichpromote safety, effectiveness and efficiency of the LENAP protocol forthe benefit of the patient.

The procedure is categorized as a Gingival Flap Procedure and limited orcomplete occlusal adjustment. Treatment time of 120 minutes isreasonable to perform two quadrants. Treatment is followed by a coronalpolishing/prophylaxis and an occlusal equilibration follow-up and apostoperative check of the area treated. In one example, the lasingsteps comprise application of the remaining ⅓ of the total light doseusing a 300-, 320-, 360-, 400-micron-diameter (preferably360-micron-diameter) quartz optical FiberFlex™ fiber fed through aTrueFlex® handpiece and bendable cannula, while operating the FR Nd:YAGlaser device within the preferred parameter range.

In one example, a topically placed anesthetic is used to anesthetize thearea. For example, a clinician may begin with 4% Prilocaine Plain, usinga 30-gauge needle. This anesthetic is perceived by the patient aspainless, due to its unique ability to anesthetize soft tissue withoutstinging. The clinician may inject the anesthetic very slowly into thearea, allowing several minutes for the Prilocaine Plain to take effect.The clinician may then continue using a 30-gauge needle, and follow thisprocedure with a suitable longer-acting anesthetic. However, anexception would be made if health reasons caused the anesthetic to becontraindicated. The area of concern usually involves two opposingquadrants and then the other two opposing quadrants some days later, oralternatively, full-mouth treatment in one appointment. Anesthesia isroutinely used in every procedure for the reasons set forth below:

a) aiding in accurate measurement of the full-depth of the diseasedpocket;

b) allowing the doctor to be aggressive in the root planing and scalingof all surfaces of the tooth;

c) allowing the patient to be as comfortable as possible during thetreatment, thereby minimizing the patient's endogenous adrenalineproduction, and in turn achieve the optimal therapy results;

d) maximizing the doctor's ability to concentrate on the procedure; and

e) optimizing the use of ultrasonic probes at frequencies between onehertz and three hundred thousand hertz.

In one example, the anesthetization is performed via a nerve block or byinfiltration.

The pocket depths should then be recorded with a periodontal probe withsix areas recorded around each tooth. This will allow a determination ofthe full depth of the diseased pocket. The eGUI may assist the clinicianin this regard by providing instructional and patient educational videosand photos; synchronization with electronic records plus tissuephenotype exemplar photographs to aid in accurate recording, saving andcomputing parameters and light dose; presentation of light dose to theclinician for approval or adjustment; and conversion of average probedepth diagnostics into J/mm average pocket depth and then to light dose,all of which promote safety, effectiveness and efficiency of the LENAPprotocol for the benefit of the patient. In one aspect, the conversionfrom probe depths/bone soundings to the total light dose estimationcomprises multiplying by 1 to 40, depending on soft tissue phenotype(biotype), LANAP® Periodontal Disease Case Type Classification I-V, andLANAP® Tooth Mobility Score 0-4.

Additionally, the appropriate application of intermittent orsimultaneous water spray should be used for tissue cooling. A contactlaser fiber with a fiber diameter of between 100 mu (microns) and 1000mu (microns), preferably 300-400 microns should be used, in anorientation along the long axis of the tooth, to create a gingivaltrough by excising the free gingival margin and the internal epitheliallining of the pocket, thus exposing the root surface and removing allinternal epithelial from the gingival pocket. The eGUI may assist theclinician by providing: procedure presets consistent with the level ofclinician training proficiency and certification; instructional andpatient educational videos and photos; use of individually selectablePulse Duration, Energy, Repetition Rate, and intuitive Average Powergroupings within a safe therapeutic treatment window; display ofmeasured power contrasted with average power settings to help ensuredelivered power matches the intended amount; ability to hold averagepower constant as repetition rate or energy settings are individuallyadjusted; a smart connector that identifies the diameter of the opticalenergy delivery system in order to adjust laser parameters accordingly;ability to hold energy density constant when optical fiber diameters arechanged; a display of Joules, Shots, Energy Density, Power Density andPeak Power settings to determine laser beam intensity, impact, andoverall effect on tissue; synchronization with electronic records plustissue phenotype exemplar photographs to aid in accurate recording,saving and computing parameters and light dose; presentation of lightdose to the clinician for approval or adjustment; conversion of averageprobe depth diagnostics into J/mm average pocket depth and then to lightdose; and an intuitive chart display of energy delivery progression ofphotobiomodulation and LENAP light dose delivery that is visuallytracked with reference bands corresponding to dosage for first andsecond pass and managed with a countdown timer according to energydelivery rates and thermal-relaxation criteria, and following the LENAPprotocol formula for the first and second laser pass—all of whichpromote safety, effectiveness and efficiency of the LENAP protocol forthe benefit of the patient.

Appropriately cleaved contact laser fibers are used for the precisecontrol of the laser energy, the physical placement of the laser energy,and the determination of the desired orientation of the laser to thetissue desired to be removed. Orientation along the long axis of thetool defines the direction of the laser fiber for the proper initialexcision. The root surface is then opened by gingival troughing forviewing.

Excising the free gingival margin with the laser energy removesaccretions and pathogens within the tissue of the free margin, whichotherwise would not be removable. Additionally, this procedure provideshemostasis for better visualization, and further defines the tissuemargins preceding mechanical instrumentation. The integrity of themucosa is also preserved by releasing tissue tension around the toothprior to mechanical manipulation, thereby dissecting the separationbetween the free gingival margin and the fibrous collagen matrix, whichholds the gingiva in position. Maintenance of the crest of the gingivalmargin is aided in that the healing of the fibrous collagen matrix willmaintain the gingival crest at, or better, than the presurgical level.The eGUI assists the clinician in that regard by providing: procedurepresets consistent with the level of clinician training proficiency andcertification; instructional and patient educational videos and photos;use of individually selectable Pulse Duration, Energy, Repetition Rate,and intuitive Average Power groupings within a safe therapeutictreatment window; display of measured power contrasted with averagepower settings to help ensure delivered power matches the intendedamount; ability to hold average power constant as repetition rate orenergy settings are individually adjusted; a smart connector thatidentifies the diameter of the optical energy delivery system in orderto adjust laser parameters accordingly; ability to hold energy densityconstant when optical fiber diameters are changed; a display of Joules,Shots, Energy Density, Power Density and Peak Power settings todetermine laser beam intensity, impact, and overall effect on tissue;synchronization with electronic records plus tissue phenotype exemplarphotographs to aid in accurate recording, saving and computingparameters and light dose; presentation of light dose to the clinicianfor approval or adjustment; conversion of average probe depthdiagnostics into J/mm average pocket depth and then to light dose; andan intuitive chart display of energy delivery progression ofphotobiomodulation and LENAP light dose delivery that is visuallytracked with reference bands corresponding to dosage for first andsecond pass and managed with a countdown timer according to energydelivery rates and thermal-relaxation criteria, and following the LENAPprotocol formula for the first and second laser pass—all of whichpromote safety, effectiveness and efficiency of the LENAP protocol forthe benefit of the patient.

By use of the “hot-tip” effect (accumulated tissue proteins heated viaconductivity secondary to the passage of laser energy through thefiber), the clinician may continue to excise the inner pocket epitheliumaround the entire tooth to the depth of the probed reading (while notbreaking through the mucogingival junction). This effect provides theselective removal of sulcular, pocket epithelium and granulation tissuewithout removing any substantial connective fibrous tissue and does socircumferentially, as long as the area is not allowed to become dryduring surgery. As necessary, the clinician may remove the excisedtissue that accumulates on the tip of the laser fiber. The eGUI assiststhe clinician in these aspects by providing: procedure presetsconsistent with the level of clinician training proficiency andcertification; instructional and patient educational videos and photos;use of individually selectable Pulse Duration, Energy, Repetition Rate,and intuitive Average Power groupings within a safe therapeutictreatment window; display of measured power contrasted with averagepower settings to help ensure delivered power matches the intendedamount; ability to hold average power constant as repetition rate orenergy settings are individually adjusted; a smart connector thatidentifies the diameter of the optical energy delivery system in orderto adjust laser parameters accordingly; ability to hold energy densityconstant when optical fiber diameters are changed; a display of Joules,Shots, Energy Density, Power Density and Peak Power settings todetermine laser beam intensity, impact, and overall effect on tissue;synchronization with electronic records plus tissue phenotype exemplarphotographs to aid in accurate recording, saving and computingparameters and light dose; presentation of light dose to the clinicianfor approval or adjustment; conversion of average probe depthdiagnostics into J/mm average pocket depth and then to light dose; andan intuitive chart display of energy delivery progression ofphotobiomodulation and LENAP light dose delivery that is visuallytracked with reference bands corresponding to dosage for first andsecond pass and managed with a countdown timer according to energydelivery rates and thermal-relaxation criteria, and following the LENAPprotocol formula for the first and second laser pass—all of whichpromote safety, effectiveness and efficiency of the LENAP protocol forthe benefit of the patient.

Next, the clinician may ultrasonically scale all root surfaces to thedepth of the pocket. The intent is to remove all foreign structures andsubstances from the pocket, thereby allowing adhesion of the lased softtissue to the clean tooth surface. Next, the clinician may carefullyroot plane and scale all cementum. This can be augmented by the use ofthe well-known, small “spoon-like” bone files which clean the surface onthe cementum exceptionally well.

Between one and one hundred Watts of fiber output power and a frequencybetween one hertz and three hundred megahertz, preferably 10-30 Hz, willthen be used in the deep periodontal pockets for optimal bacterialdestruction without causing bacterial injection into the periodontaltissues. This will minimize a soft tissue cellulitis. By using the laserfiber, the clinician may explore for remaining calculus and/or rootroughness. These small fibers are very adept at detection of any surfaceirregularities. The clinician may continue or repeat, if necessary, anyor all of the steps above, as needed, to achieve a smooth and clean rootsurface.

Again, the laser is used in the pocket to remove large areas ofgranulation tissue, disinfect tissue, assist in hemostasis, cauterizefree nerve endings, seal lymphatics and prepare tissue for welding anddesensitizing teeth. The eGUI assists the clinician in this regard byproviding: procedure presets consistent with the level of cliniciantraining proficiency and certification; instructional and patienteducational videos and photos; use of individually selectable PulseDuration, Energy, Repetition Rate, and intuitive Average Power groupingswithin a safe therapeutic treatment window; display of measured powercontrasted with average power settings to help ensure delivered powermatches the intended amount; ability to hold average power constant asrepetition rate or energy settings are individually adjusted; a smartconnector that identifies the diameter of the optical energy deliverysystem in order to adjust laser parameters accordingly; ability to holdenergy density constant when optical fiber diameters are changed; adisplay of Joules, Shots, Energy Density, Power Density and Peak Powersettings to determine laser beam intensity, impact, and overall effecton tissue; synchronization with electronic records plus tissue phenotypeexemplar photographs to aid in accurate recording, saving and computingparameters and light dose; presentation of light dose to the clinicianfor approval or adjustment; conversion of average probe depthdiagnostics into J/mm average pocket depth and then to light dose; andan intuitive chart display of energy delivery progression ofphotobiomodulation and LENAP light dose delivery that is visuallytracked with reference bands corresponding to dosage for first andsecond pass and managed with a countdown timer according to energydelivery rates and thermal-relaxation criteria, and following the LENAPprotocol formula for the first and second laser pass—all of whichpromote safety, effectiveness and efficiency of the LENAP protocol forthe benefit of the patient. The area should be rinsed with water toremove any residue, calculus or blood clots; also, the laser may be usedfor touch-up if needed.

Elimination of all occlusal prematurities and interferences, centricworking and balancing is done to allow healing of the tissue and boneregeneration. An occlusal splint is necessary when trauma-inducedperiodontal disease is manifest, i.e., occlusal trauma in the presenceof bacteria-induced periodontal disease. Master impressions for ananterior deprogrammer and dis-occluding occlusal splint are taken. Thesplint is designed to provide anterior guidance, i.e., a “LANAP Splint”is the appliance of choice. In one example, the splint is delivered atan appointment that is scheduled one week after the postoperativeappointment. At this time it can be adjusted accordingly for toothstabilization.

All treatment sites are irrigated to the deepest depth of theperiodontal pockets with a bactericidal solution consisting of a hightissue substantivity (e.g., chlorhexidine gluconate 0.12%). Theirrigation aids the laser in the reduction of bacteria in the pocket andin removing debris.

In one example, cleaning comprises application of a piezo-electricultrasonic device with water lavage and 20,000 to 30,000 hertz and useof appropriate tips operating at 8 to 10 Watts.

The clinician may approximate the wound edges and, using the laser,control oozing as needed. Healing of the wound edges by secondaryintention is imperative.

The tissues should be compressed with wet gauze for two to three minutesagainst the tooth from both a facial and lingual direction, permittingonly a thin clot to form between the tissue and the tooth.

Medications should be prescribed for home use, and a review ofpostoperative care should be discussed with the patient. A postoperativeappointment should be scheduled within seven to ten days. Perform athrough occlusal equilibration follow-up.

This treatment should be continued periodically until bone developmentis complete. Appointments should continue for one full year.

The procedure will now be described in further detail. As mentionedabove, for purposes of efficiency reference may be made again to FIGS.68 to 70.

To reiterate, FIG. 68 is a section of a gingival tissue prior to theadministration of a LANAP® procedure according to an example embodiment.FIG. 69 is a section of the same gingival tissue as in FIG. 68 showingthe position of surgical tissue severing according to an exampleembodiment. FIG. 70 is a section of the same gingival tissue as in FIG.68 after completion of a LANAP® procedure according to an exampleembodiment.

The above-described figures illustrate a method for treating gingivaldisease. An excisional new attachment procedure comprises a step-by-stepapproach. First, the gingival tissue 5 corresponding to a targeted tooth10 is anesthetized. The depth of a pocket 20 in the gingival tissue ismeasured, preferably with a periodontal probe 30, taking at least sixspaced-apart measurements around the tooth 10. The pocket depth isdefined as extending from the upper gingival margin 40 to themucogingival junction 50. The eGUI assists the clinician in this regardby providing: instructional and patient educational videos and photos;synchronization with electronic records plus tissue phenotype exemplarphotographs to aid in accurate recording, saving and computingparameters and light dose; presentation of light dose to the clinicianfor approval or adjustment; and conversion of average probe depthdiagnostics into J/mm average pocket depth and then to light dose, allof which promote safety, effectiveness and efficiency of the LENAPprotocol for the benefit of the patient.

The interior epithelial lining 60 of the pocket 20 is then ablated andvaporized to the full depth of the pocket 20, preferably using a laserfiber having a preferred diameter of between 100 microns and 1000microns, the fiber preferably held oriented with the axis of the tooth10. This is completed and on all sides of the tooth 10. This stepgenerates and prepares a new pocket tissue surface 70. Preferably notmore than 100 Watts of fiber output power is used, as measured at adistal end of the fiber, and a lasing frequency of not more than 300megahertz is preferably applied. Preferably, water is sprayed into thepocket 20 for cooling during the ablating and vaporizing step. The eGUImay assist the clinician in this process by providing: procedure presetsconsistent with the level of clinician training proficiency andcertification; instructional and patient educational videos and photos;use of individually selectable Pulse Duration, Energy, Repetition Rate,and intuitive Average Power groupings within a safe therapeutictreatment window; display of measured power contrasted with averagepower settings to help ensure delivered power matches the intendedamount; ability to hold average power constant as repetition rate orenergy settings are individually adjusted; a smart connector thatidentifies the diameter of the optical energy delivery system in orderto adjust laser parameters accordingly; ability to hold energy densityconstant when optical fiber diameters are changed; a display of Joules,Shots, Energy Density, Power Density and Peak Power settings todetermine laser beam intensity, impact, and overall effect on tissue;synchronization with electronic records plus tissue phenotype exemplarphotographs to aid in accurate recording, saving and computingparameters and light dose; presentation of light dose to the clinicianfor approval or adjustment; conversion of average probe depthdiagnostics into J/mm average pocket depth and then to light dose; andan intuitive chart display of energy delivery progression ofphotobiomodulation and LENAP light dose delivery that is visuallytracked with reference bands corresponding to dosage for first andsecond pass and managed with a countdown timer according to energydelivery rates and thermal-relaxation criteria, and following the LENAPprotocol formula for the first and second laser pass—all of whichpromote safety, effectiveness and efficiency of the LENAP protocol forthe benefit of the patient.

In one example, ablating and vaporizing comprises application of ⅔ ofthe total light dose using a 360-micron-diameter quartz FiberFlex™optical fiber fed through a TrueFlex® handpiece and a bendable cannula,while operating the FR Nd:YAG laser device within the preferredparameter range.

Next, the surface of the tooth 10A is cleaned of all foreign matter 10B,again, to the depth of the pocket 20 on all sides of the tooth 10. Next,the pocket 10 is lased to remove granulation tissue, and to disinfect,assist in hemostatis, cauterize free nerve endings, and seal lymphatics,of the pocket tissue surface. Lasing also prepares the pocket tissuesurface 70 for welding, and also desensitizes the tooth. The eGUI canassist the clinician by providing: procedure presets consistent with thelevel of clinician training proficiency and certification; instructionaland patient educational videos and photos; use of individuallyselectable Pulse Duration, Energy, Repetition Rate, and intuitiveAverage Power groupings within a safe therapeutic treatment window;display of measured power contrasted with average power settings to helpensure delivered power matches the intended amount; ability to holdaverage power constant as repetition rate or energy settings areindividually adjusted; a smart connector that identifies the diameter ofthe optical energy delivery system in order to adjust laser parametersaccordingly; ability to hold energy density constant when optical fiberdiameters are changed; a display of Joules, Shots, Energy Density, PowerDensity and Peak Power settings to determine laser beam intensity,impact, and overall effect on tissue; synchronization with electronicrecords plus tissue phenotype exemplar photographs to aid in accuraterecording, saving and computing parameters and light dose; presentationof light dose to the clinician for approval or adjustment; conversion ofaverage probe depth diagnostics into J/mm average pocket depth and thento light dose; and an intuitive chart display of energy deliveryprogression of photobiomodulation and LENAP light dose delivery that isvisually tracked with reference bands corresponding to dosage for firstand second pass and managed with a countdown timer according to energydelivery rates and thermal-relaxation criteria, and following the LENAPprotocol formula for the first and second laser pass—all of whichpromote safety, effectiveness and efficiency of the LENAP protocol forthe benefit of the patient. All debris is then rinsed from the pocket20. This is followed by an irrigation of the pocket 20 with abactericidal solution.

Next, occlusal interferences are eliminated. The new pocket tissuesurface 70 is lased to adapt it for tissue welding. The eGUI may assistthe clinician by providing: procedure presets consistent with the levelof clinician training proficiency and certification; instructional andpatient educational videos and photos; use of individually selectablePulse Duration, Energy, Repetition Rate, and intuitive Average Powergroupings within a safe therapeutic treatment window; display ofmeasured power contrasted with average power settings to help ensuredelivered power matches the intended amount; ability to hold averagepower constant as repetition rate or energy settings are individuallyadjusted; a smart connector that identifies the diameter of the opticalenergy delivery system in order to adjust laser parameters accordingly;ability to hold energy density constant when optical fiber diameters arechanged; a display of Joules, Shots, Energy Density, Power Density andPeak Power settings to determine laser beam intensity, impact, andoverall effect on tissue; synchronization with electronic records plustissue phenotype exemplar photographs to aid in accurate recording,saving and computing parameters and light dose; presentation of lightdose to the clinician for approval or adjustment; conversion of averageprobe depth diagnostics into J/mm average pocket depth and then to lightdose; and an intuitive chart display of energy delivery progression ofphotobiomodulation and LENAP light dose delivery that is visuallytracked with reference bands corresponding to dosage for first andsecond pass and managed with a countdown timer according to energydelivery rates and thermal-relaxation criteria, and following the LENAPprotocol formula for the first and second laser pass—all of whichpromote safety, effectiveness and efficiency of the LENAP protocol forthe benefit of the patient.

The pocket tissue surface 70 is approximated with the tooth surface 10Apreferably using wet gauze to hold the pocket tissue surface 70 incontact with the tooth surface 10A, preferably from 2 to 3 minutesallowing a thin clot 80 to form between the pocket tissue surface 70 andthe tooth surface 10A so as to advance and assure adhesion of thesetissues. Finally, the body's natural immune system is enhanced byprescribed medications for outpatient use in preventing infection. Thisimportant step is necessary in order to protect against infection andreduce inflammation. The procedure preferably includes the further stepof providing at least one subsequent occlusal equilibration examination.

A recapitulation of the above description with further details follows:

The area of concern, usually two quadrants, is anesthetized. Theprocedure is applied independently to each tooth involved. Pocket depthis measured and recorded with a perio probe to determine the full depthof the diseased pocket. A contact laser fiber is oriented along the longaxis of the tooth, and is used to create a gingival trough by excisingthe free gingival margin and the internal epithelial lining of thepocket, thereby exposing the root surface. Appropriately cleaved contactlaser fibers provide precise control of the laser energy, the physicalplacement of the laser energy, and the determination of the desiredphysical orientation of the laser to the tissue to be removed. Gingivaltroughing is used to access the root surface. Excision of the freegingival margin removes accretions and pathogens within the tissue ofthe free margin which are otherwise unremovable, and provides hemostasisfor better visualization. This step also defines the tissue marginspreceding mechanical instrumentation, and preserves the integrity of themucosa by releasing tissue tension. It also dissects-out the separationbetween the free gingival margin and the fibrous collagen matrix whichholds the gingiva in position. This aids in the maintenance of the crestof the gingival margin. With the use of the “hot-tip” effect, furtherexcision of the inner pocket epithelium around the entire tooth iscompleted, to the depth of the probe readings. No attempt is made tobreak through the mucogingival junction. The “hot-tip” effect(accumulated tissue proteins heated via conductivity secondary to thepassage of laser energy through the fiber) provides the selectiveremoval of sulcular and pocket epithelium and granulation tissue withoutremoving substantially any connective fibrous tissue, and does socircumferentially. As necessary, the excised tissue that accumulates onthe tip of the laser fiber is removed. The eGUI assists the clinician inperforming the laser delivery steps of the LENAP protocol by providing:procedure presets consistent with the level of clinician trainingproficiency and certification; instructional and patient educationalvideos and photos; use of individually selectable Pulse Duration,Energy, Repetition Rate, and intuitive Average Power groupings within asafe therapeutic treatment window; display of measured power contrastedwith average power settings to help ensure delivered power matches theintended amount; ability to hold average power constant as repetitionrate or energy settings are individually adjusted; a smart connectorthat identifies the diameter of the optical energy delivery system inorder to adjust laser parameters accordingly; ability to hold energydensity constant when optical fiber diameters are changed; a display ofJoules, Shots, Energy Density, Power Density and Peak Power settings todetermine laser beam intensity, impact, and overall effect on tissue;synchronization with electronic records plus tissue phenotype exemplarphotographs to aid in accurate recording, saving and computingparameters and light dose; presentation of light dose to the clinicianfor approval or adjustment; conversion of average probe depthdiagnostics into J/mm average pocket depth and then to light dose; andan intuitive chart display of energy delivery progression ofphotobiomodulation and LENAP light dose delivery that is visuallytracked with reference bands corresponding to dosage for first andsecond pass and managed with a countdown timer according to energydelivery rates and thermal-relaxation criteria, and following the LENAPprotocol formula for the first and second laser pass—all of whichpromote safety, effectiveness and efficiency of the LENAP protocol forthe benefit of the patient.

Ultrasonic scaling of all root surfaces to the depth of pocket iscompleted. The intent is to remove all foreign structures and substancefrom the pocket to allow adhesion of the soft tissue to the clean toothsurface. Careful root planing and scaling of all cementum is completed.This can be augmented by the use of small, spoon-like bone files, whichare highly effective in cleaning the surface of the cementum. The laserfiber is used to explore for remaining calculus and/or root roughness.These small fibers are very adept at detection of any surfaceirregularities. Lasing of the pocket to remove large areas ofgranulation tissue, disinfect tissue, assist in hemostasis, cauterizefree nerve endings, seal lymphatics, prepare tissue for welding anddesensitize those teeth that are sensitive is accomplished. The eGUI canassist the clinician in this regard by providing: procedure presetsconsistent with the level of clinician training proficiency andcertification; instructional and patient educational videos and photos;use of individually selectable Pulse Duration, Energy, Repetition Rate,and intuitive Average Power groupings within a safe therapeutictreatment window; display of measured power contrasted with averagepower settings to help ensure delivered power matches the intendedamount; ability to hold average power constant as repetition rate orenergy settings are individually adjusted; a smart connector thatidentifies the diameter of the optical energy delivery system in orderto adjust laser parameters accordingly; ability to hold energy densityconstant when optical fiber diameters are changed; a display of Joules,Shots, Energy Density, Power Density and Peak Power settings todetermine laser beam intensity, impact, and overall effect on tissue;synchronization with electronic records plus tissue phenotype exemplarphotographs to aid in accurate recording, saving and computingparameters and light dose; presentation of light dose to the clinicianfor approval or adjustment; conversion of average probe depthdiagnostics into J/mm average pocket depth and then to light dose; andan intuitive chart display of energy delivery progression ofphotobiomodulation and LENAP light dose delivery that is visuallytracked with reference bands corresponding to dosage for first andsecond pass and managed with a countdown timer according to energydelivery rates and thermal-relaxation criteria, and following the LENAPprotocol formula for the first and second laser pass—all of whichpromote safety, effectiveness and efficiency of the LENAP protocol forthe benefit of the patient.

The areas are rinsed with water to remove any residue, calculus andblood clots. Elimination of all occlusal interferences, centric, workingand balancing, is completed. For best results this step is imperativesince it allows the tissue to heal and the bone to regenerate. The lasermodifies the tissue to allow new attachment to take place but if thetrauma of malocclusion continues the tissue cannot withstand and beginsto break down immediately. All treatment sites are irrigated to thedeepest depth of the periodontal pockets with a bactericidal solution ofa high tissue substantivity (e.g., chlorhexidine gluconate 0.12%). Theirrigation aids the laser in the reduction of bacteria in the pocket andin removing debris. Approximation of the wound edges is completed.Lasing is further accomplished to control oozing as needed. Healing ofthe wound edges by secondary intention is imperative. The eGUI assiststhe clinician in performing the laser delivery steps of the LENAPprotocol by providing: procedure presets consistent with the level ofclinician training proficiency and certification; instructional andpatient educational videos and photos; use of individually selectablePulse Duration, Energy, Repetition Rate, and intuitive Average Powergroupings within a safe therapeutic treatment window; display ofmeasured power contrasted with average power settings to help ensuredelivered power matches the intended amount; ability to hold averagepower constant as repetition rate or energy settings are individuallyadjusted; a smart connector that identifies the diameter of the opticalenergy delivery system in order to adjust laser parameters accordingly;ability to hold energy density constant when optical fiber diameters arechanged; a display of Joules, Shots, Energy Density, Power Density andPeak Power settings to determine laser beam intensity, impact, andoverall effect on tissue; synchronization with electronic records plustissue phenotype exemplar photographs to aid in accurate recording,saving and computing parameters and light dose; presentation of lightdose to the clinician for approval or adjustment; conversion of averageprobe depth diagnostics into J/mm average pocket depth and then to lightdose; and an intuitive chart display of energy delivery progression ofphotobiomodulation and LENAP light dose delivery that is visuallytracked with reference bands corresponding to dosage for first andsecond pass and managed with a countdown timer according to energydelivery rates and thermal-relaxation criteria, and following the LENAPprotocol formula for the first and second laser pass—all of whichpromote safety, effectiveness and efficiency of the LENAP protocol forthe benefit of the patient. The tissue is compressed with wet gauze for2 to 3 minutes against the tooth from both a facial and lingualdirection in order to permit only a thin clot to form between the tissueand the tooth.

Post-procedural steps include prescribing medications for home use andreviewing postoperative care with the patient. Master impressions for ananterior deprogrammer and dis-occluding occlusal splint are taken. Thesplint is designed to provide anterior guidance, i.e., a “LANAP Splint”is the appliance of choice. This will be delivered at the postoperativeappointment and adjusted as needed for tooth/teeth stabilization. Athorough occlusal equilibration follow-up examination is required. Thistreatment should continue periodically until bone development iscomplete. Pocket-depth readings at 60, 120 and 180 days duringcontinuing care appointments are desirable.

Thus, according to this example embodiment, an excisional new attachmentprocedure includes a) anesthetizing a gingival tissue corresponding to atargeted tooth of a patient the tooth having a tooth surface, b)measuring a depth of a pocket in the gingival tissue, from an uppergingival margin to a mucogingival junction, and c) ablating andvaporizing an interior epithelial lining of the pocket, to the depth ofthe pocket on all sides of the tooth to prepare a new pocket tissuesurface. The procedure further includes d) cleaning the tooth surface ofall foreign matter, to the depth of the pocket on all sides of thetooth, and e) lasing the pocket to remove granulation tissue, and to:disinfect, assist in hemostatis, cauterize free nerve endings, and seallymphatics of the pocket tissue surface, and to prepare the pockettissue surface for welding, and to desensitize the tooth. In addition,the procedure includes f) rinsing the pocket to remove debris, g)irrigating the pocket with a bactericidal solution, h) eliminatingocclusal interferences, and i) lasing the pocket tissue surface to adaptthe pocket tissue surface for tissue welding. The procedure alsoincludes j) approximating the pocket tissue surface with the toothsurface, and k) maintaining the pocket tissue surface in contact withthe tooth surface to advance adhesion.

The eGUI can assist the clinician in the above by using instructionaland patient educational videos and photos stored on the device topromote safety, effectiveness and efficiency using the laser. The eGUIcan further assist the clinician by using procedure presets on thedevice consistent with the level of clinician training proficiency andcertification to promote safety, effectiveness and efficiency. Moreover,the eGUI can assist the clinician by using individually selectable PulseDuration, Energy, Repetition Rate, and intuitive Average Power groupingswithin a safe therapeutic treatment window available and programmed onthe device to promote safety, effectiveness and efficiency. The eGUI candisplay measured power contrasted with average power settings to helpensure delivered power matches the intended amount to promote safety,effectiveness and efficiency. Further, the eGUI can assist the clinicianby providing the ability to hold average power constant as repetitionrate or energy settings are individually adjusted to promote safety,effectiveness and efficiency. The eGUI can also assist the clinician byusing (and communicating with) a smart connector that identifies thediameter of the optical energy delivery system in order to adjust laserparameters accordingly to promote safety, effectiveness and efficiency.Moreover, the eGUI enhances this aspect by holding energy densityconstant when optical fiber diameters are changed to promote safety,effectiveness and efficiency. Additionally, the eGUI can assist theclinician by displaying Joules, Shots, Energy Density, Power Density andPeak Power settings to determine laser beam intensity, impact, andoverall effect on tissue to promote safety, effectiveness andefficiency. Additionally, the eGUI can assist the clinician by usingdevice synchronization with electronic records, plus tissue phenotypeexemplar photographs on the device to aid in accurate recording, savingand computing parameters and light dose to promote safety, effectivenessand efficiency. The eGUI can further assist by presenting a light doseto the clinician for approval or adjustment to promote safety,effectiveness and efficiency. In addition, the eGUI can assist theclinician by conversion of average probe depth diagnostics into J/mmaverage pocket depth and then to light dose to promote safety,effectiveness and efficiency. The eGUI can also assist the clinician byan intuitive chart display of energy delivery progression ofphotobiomodulation and LENAP light dose delivery that is visuallytracked with reference bands corresponding to dosage for the first andsecond pass and managed with a countdown timer according to energydelivery rates and thermal-relaxation criteria, and following the LENAPprotocol formula for the first and second laser pass to promote safety,effectiveness and efficiency.

In one aspect, the ablating and vaporizing, and the lasing is completedwith a laser fiber held oriented with the axis of the tooth. The eGUIcan assist the clinician in this regard by using instructional andpatient educational videos and photos stored on the device to promotesafety, effectiveness and efficiency using the laser. The eGUI canfurther assist the clinician by using procedure presets on the deviceconsistent with the level of clinician training proficiency andcertification to promote safety, effectiveness and efficiency. Moreover,the eGUI can assist the clinician by using individually selectable PulseDuration, Energy, Repetition Rate, and intuitive Average Power groupingswithin a safe therapeutic treatment window available and programmed onthe device to promote safety, effectiveness and efficiency. The eGUI candisplay measured power contrasted with average power settings to helpensure delivered power matches the intended amount to promote safety,effectiveness and efficiency. Further, the eGUI can assist the clinicianby providing the ability to hold average power constant as repetitionrate or energy settings are individually adjusted to promote safety,effectiveness and efficiency. The eGUI can also assist the clinician byusing (and communicating with) a smart connector that identifies thediameter of the optical energy delivery system in order to adjust laserparameters accordingly to promote safety, effectiveness and efficiency.Moreover, the eGUI enhances this aspect by holding energy densityconstant when optical fiber diameters are changed to promote safety,effectiveness and efficiency. Additionally, the eGUI can assist theclinician by displaying Joules, Shots, Energy Density, Power Density andPeak Power settings to determine laser beam intensity, impact, andoverall effect on tissue to promote safety, effectiveness andefficiency. Additionally, the eGUI can assist the clinician by usingdevice synchronization with electronic records, plus tissue phenotypeexemplar photographs on the device to aid in accurate recording, savingand computing parameters and light dose to promote safety, effectivenessand efficiency. The eGUI can further assist by presenting a light doseto the clinician for approval or adjustment to promote safety,effectiveness and efficiency. In addition, the eGUI can assist theclinician by conversion of average probe depth diagnostics into J/mmaverage pocket depth and then to light dose to promote safety,effectiveness and efficiency. The eGUI can also assist the clinician byan intuitive chart display of energy delivery progression ofphotobiomodulation and LENAP light dose delivery that is visuallytracked with reference bands corresponding to dosage for the first andsecond pass and managed with a countdown timer according to energydelivery rates and thermal-relaxation criteria, and following the LENAPprotocol formula for the first and second laser pass to promote safety,effectiveness and efficiency.

In another aspect, the depth measuring is completed with a periodontalprobe taking at least six spaced-apart measurements around the tooth.The eGUI can assist the clinician in this regard by using instructionaland patient educational videos and photos stored on the device topromote safety, effectiveness and efficiency.

In yet another aspect, the method includes providing the laser, and theablating and vaporizing is completed with not more than 100 Watts ofoutput power from the laser, as measured at a distal end of a laserfiber of the laser, and with a lasing frequency of not more than 300megahertz. The eGUI can assist the clinician in this regard by usinginstructional and patient educational videos and photos stored on thedevice to promote safety, effectiveness and efficiency using the laser.The eGUI can further assist the clinician by using procedure presets onthe device consistent with the level of clinician training proficiencyand certification to promote safety, effectiveness and efficiency.Moreover, the eGUI can assist the clinician by using individuallyselectable Pulse Duration, Energy, Repetition Rate, and intuitiveAverage Power groupings within a safe therapeutic treatment windowavailable and programmed on the device to promote safety, effectivenessand efficiency. The eGUI can display measured power contrasted withaverage power settings to help ensure delivered power matches theintended amount to promote safety, effectiveness and efficiency.Further, the eGUI can assist the clinician by providing the ability tohold average power constant as repetition rate or energy settings areindividually adjusted to promote safety, effectiveness and efficiency.The eGUI can also assist the clinician by using (and communicating with)a smart connector that identifies the diameter of the optical energydelivery system in order to adjust laser parameters accordingly topromote safety, effectiveness and efficiency. Moreover, the eGUIenhances this aspect by holding energy density constant when opticalfiber diameters are changed to promote safety, effectiveness andefficiency. Additionally, the eGUI can assist the clinician bydisplaying Joules, Shots, Energy Density, Power Density and Peak Powersettings to determine laser beam intensity, impact, and overall effecton tissue to promote safety, effectiveness and efficiency. Additionally,the eGUI can assist the clinician by using device synchronization withelectronic records, plus tissue phenotype exemplar photographs on thedevice to aid in accurate recording, saving and computing parameters andlight dose to promote safety, effectiveness and efficiency. The eGUI canfurther assist by presenting a light dose to the clinician for approvalor adjustment to promote safety, effectiveness and efficiency. Inaddition, the eGUI can assist the clinician by conversion of averageprobe depth diagnostics into J/mm average pocket depth and then to lightdose to promote safety, effectiveness and efficiency. The eGUI can alsoassist the clinician by an intuitive chart display of energy deliveryprogression of photobiomodulation and LENAP light dose delivery that isvisually tracked with reference bands corresponding to dosage for thefirst and second pass and managed with a countdown timer according toenergy delivery rates and thermal-relaxation criteria, and following theLENAP protocol formula for the first and second laser pass to promotesafety, effectiveness and efficiency.

In still another aspect, the method includes spraying water onto thepocket tissue surface for cooling the pocket tissue surface during theablating and vaporizing step. The eGUI can assist the clinician in thisregard by using (e.g., displaying) instructional and patient educationalvideos and photos stored on the device to promote safety, effectivenessand efficiency.

In yet another aspect, the laser fiber is of a diameter of betweenapproximately 100 microns and 1000 microns. The eGUI can assist theclinician in this regard by using instructional and patient educationalvideos and photos stored on the device to promote safety, effectivenessand efficiency using the laser. The eGUI can further assist theclinician by using procedure presets on the device consistent with thelevel of clinician training proficiency and certification to promotesafety, effectiveness and efficiency. Moreover, the eGUI can assist theclinician by using individually selectable Pulse Duration, Energy,Repetition Rate, and intuitive Average Power groupings within a safetherapeutic treatment window available and programmed on the device topromote safety, effectiveness and efficiency. The eGUI can displaymeasured power contrasted with average power settings to help ensuredelivered power matches the intended amount to promote safety,effectiveness and efficiency. Further, the eGUI can assist the clinicianby providing the ability to hold average power constant as repetitionrate or energy settings are individually adjusted to promote safety,effectiveness and efficiency. The eGUI can also assist the clinician byusing (and communicating with) a smart connector that identifies thediameter of the optical energy delivery system in order to adjust laserparameters accordingly to promote safety, effectiveness and efficiency.Moreover, the eGUI enhances this aspect by holding energy densityconstant when optical fiber diameters are changed to promote safety,effectiveness and efficiency. Additionally, the eGUI can assist theclinician by displaying Joules, Shots, Energy Density, Power Density andPeak Power settings to determine laser beam intensity, impact, andoverall effect on tissue to promote safety, effectiveness andefficiency. Additionally, the eGUI can assist the clinician by usingdevice synchronization with electronic records, plus tissue phenotypeexemplar photographs on the device to aid in accurate recording, savingand computing parameters and light dose to promote safety, effectivenessand efficiency. The eGUI can further assist by presenting a light doseto the clinician for approval or adjustment to promote safety,effectiveness and efficiency. In addition, the eGUI can assist theclinician by conversion of average probe depth diagnostics into J/mmaverage pocket depth and then to light dose to promote safety,effectiveness and efficiency. The eGUI can also assist the clinician byan intuitive chart display of energy delivery progression ofphotobiomodulation and LENAP light dose delivery that is visuallytracked with reference bands corresponding to dosage for the first andsecond pass and managed with a countdown timer according to energydelivery rates and thermal-relaxation criteria, and following the LENAPprotocol formula for the first and second laser pass to promote safety,effectiveness and efficiency.

In another aspect, maintaining the pocket tissue surface in contact withthe tooth surface includes using wet gauze to hold the pocket tissuesurface in contact with the tooth surface from 2 to 3 minutes allowing athin clot to form between the pocket tissue surface and the toothsurface. The eGUI can assist the clinician in this regard by usinginstructional and patient educational videos and photos stored on thedevice to promote safety, effectiveness and efficiency.

In one aspect, the method may further include prescribing medicationsfor outpatient use in preventing infection. The eGUI can assist theclinician in this regard by using instructional and patient educationalvideos and photos stored on the device to promote safety, effectivenessand efficiency.

In another aspect, the method may further include providing at least onesubsequent occlusal equilibration examination. Again, the eGUI canassist the clinician in this regard by using instructional and patienteducational videos and photos stored on the device to promote safety,effectiveness and efficiency.

In another aspect, the method may further include enhancing thepatient's natural immune system to protect against infection and reduceinflammation. Yet again, the eGUI can assist the clinician in thisregard by using instructional and patient educational videos and photosstored on the device to promote safety, effectiveness and efficiency.

Relational Database

FIG. 71 is a view for explaining a relational database according to anexample embodiment. The relational database may be stored in, forexample, non-volatile memory 411 in tablet 400. In an alternativeembodiment, this information might be stored at main laser computer 300,or at data appliance 427.

In that regard, the database contains data that is recorded and used asa durable data archive. The database may be transportable, i.e., it canbe extracted and reinstalled in another device for (a) duplicate archiveor (b) analytical purposes. The database can be installed on alternatedevices running disparate operating systems including UNIX and Windows.In addition, the database can be synchronized with electronic medical(dental) records. Synchronized data can be operated upon by algorithmsto determine recommended treatments of laser dosimetry.

As shown in FIG. 71, sets of data include users 7101, patients 7104,treatments 7102, procedures 7107, laserheads 7103, android_metadata7105, and sqlite_sequence 7106.

Users 7101 includes information about the user of the laser (e.g., aclinician or dentist) and includes, for example, an ID, a username, anda password. The ID links to patients in patients 7104 associated withthe user, treatments 7102 associated with the user such as treatmentsperformed by the user, and procedures 7107 such as those which areauthorized for that user's level of training. For example, users 7101may include a record of user_ids, usernames, and passwords. The _idrecord is a key field and is linked to the user_id record in the tablesfor patients (7104), procedures (7107) and treatments (7102). In oneexample, username and password fields are used to authenticate userlogin credentials.

Patients 7104 includes information about patients associated with auser, including, for example, name, phone number, address, andinformation concerning LANAP® and LAPIP® procedures which may have beenperformed on the patient. Data recorded by a particular user_id may belisted for archival purposes. Standard patient master record informationis included here including names, addresses, case number (file number),etc.

Treatments 7102 includes information about treatments performed with thelaser, including, e.g., laser parameters such as a pulse width andenergy and information concerning tooth groups or implants which aretreated. To that end, treatments 7102 links to an ID of the user inusers 7101, the patient in patients 7104, and a procedure name inprocedures 7107 associated with the treatment.

More specifically, treatments 7102 (i.e., the treatments table) is arecord of therapeutic laser light dosimetry administered to a specificpatient at a specific location in the mouth, recorded by date, time andduration of laser light application.

In that regard, the specific location in the mouth may be described bythe dental arch quadrant or sextant, tooth location by number, toothcharacteristic such as missing, implant or crown at the numberedlocation. Ad hoc groupings of teeth within a quadrant or sextant can bedesignated by the user_id (clinician) and recorded in the database. Thelaser light dosimetry is characterized by the pulse width (pee), energy(joules) and pulse repetition rate (Hz) of the laser energy administeredduring the duration of the laser light application. These three valuesare collectively “therapeutic parameters”. The joules and number oflaser pulses or “shots” accumulated for the duration of the laser lightapplication are recorded. Some combinations of therapeutic parametersare given Procedural Names such as “LANAP Ablation”. Other combinationsof therapeutic parameters can be named by the clinician to aid his/hermemory. Procedural Names or clinician-named therapeutic parameters whenselected are also recorded in the database.

Procedures 7107 includes information about the procedures for whichtreatment is performed, such as ablation, hemostasis and the like. Forexample, procedures 7107 includes default parameters and procedurenames, and also includes authorized procedures for a user (who isidentified by a corresponding user ID in users 7101). In that regard, inone embodiment, procedural names for therapeutic parameters stored inprocedures 7107 are authorized for each user_id. Laser light dosimetryadministered to a specific patient and stored in treatments 7102 mayalso include the user_id of the clinician performing the procedure.

In one example, data elements or fields include the user_id of theclinician authorized to perform the procedure. This is keyed to thetraining program with advanced procedures being authorized via upgradedpasswords as the clinical training and qualifications of the userprogress. In that regard, in the procedures table 7107, the procedureauthorized field may be a tristate variable, i.e., it assumes one ofthree values: 0: =procedure not authorized for this user_id, 1:=procedure authorized but may not be overwritten by this user_id, and 2:=procedure authorized and may be overwritten by this user_id.

Other data elements of procedures 7107 may include the procedure name, aclinical photograph or motion picture illustrating the clinicalprocedure techniques and expected clinical outcomes, the therapeuticparameters, the diameter of the optical fiber used for the intendedprocedure, and the factory settings for the procedure in the event theuser_id performs a therapeutic parameter overwrite and would like torecover (restore) the recommended settings.

Laserheads 7103 includes identifying and maintenance information aboutthe laser head, such as an ID, name, and usage information. For example,laserheads 7103 may store the historical record for total time used andtotal energy output during laser operation. This is used by repair andmanufacturing facilities for evaluating mean time between failures andthe operational stress exposure of critical components. The serialnumber of the laser head may also be recorded here, and new laser headserial numbers can be added as the laserheads are replaced duringservice.

Android_metadata 7105 includes metadata associated with tablet 400 suchas, for example, locale information identifying where the tablet isbeing used.

Sqlite_sequence 7106 includes, e.g., information for managing therelational database.

The database can be operated upon by select and update queries. Selectqueries can be used to extract and format report data using filtersdeployed on the display subsystem and other devices. Update queriesassist with data synchronization and archiving across platforms. Selectqueries make data filters and include parameters such as the beginningand ending values of a time interval, for a specific or all user_ids.The listing within the time interval can be: (1) chronological, (2) bypatient and then chronological or (3) by patient and chronologicalwithin treatment site locations. These data can be further filtered toshow detailed data, summary data, and a combination of both detailed andsummary data.

In one example, two “smart filters” are provided: “Filter Patients”indicates a listing limited to those patient names found within the timeinterval and user_id selections, where the user may select or deselectpatient names to formulate the most useful report, and “Filter Site”,which is a smart filter showing those treatment site quadrants orsextants which have been treated during the time interval and user_idsselected. Again, the user may select or deselect treatment sites toformulate the most useful report.

Footswitch

FIG. 72 is a view for explaining operation of a footswitch, e.g.,footswitch 314. In particular, as shown in FIG. 72, a user operates thelaser by pressing down with a foot 7201 on footswitch 314. The physicalnature of footswitch 314 may vary. For example, footswitch 314 mightalso be a raised disc on a circular platform. In addition, footswitch314 might include a footswitch guard, and might be configured to performwireless communication with other elements of the system.

Laser Cavity

FIGS. 73 and 74 are views for explaining delivery of laser light througha laser cavity. For example, these structures may be used to deliverboth a) pulsed energy from a laser device such as a Nd:YAG laser and b)blue light from a blue light device with wavelength emission in therange of 400 to 520 nm, such as a diode laser, Ti:sapphire laser, argonion laser, light-emitting diode, superluminescent diode, halogen,plasma-arc curing (PAC), or other light source. In that regard, somehandpieces (e.g., a handpiece laser such as laser 103) may have compactand/or different dimensions and arrangements, and therefore additionalfeatures are added to guide types of light through the device.

For example, FIG. 73 depicts one example embodiment in which Nd:YAGlaser light beam 7301 or blue laser light 7302 are input into areflector element 7303. Reflector element 7303 uses mirrors or otherreflective material to direct either beam into an output beam 7304. Acommon laser delivery system 103 is used to transmit either wavelength.The reflectance (R) values of reflector element 7303 are designed toallow this beam management to occur.

Meanwhile, FIG. 74 depicts an example embodiment using a beam combiner.In FIG. 74, an invisible infrared Nd:YAG beam 7401 and a visible aimingbeam 7402 are input to a reflector. The infrared beam is allowed to passthrough as transmitted beam 7404, whereas the aiming beam 7402 isreflected as a reflected beam 7405. The two beams may be deliveredsimultaneously and coaxially through common delivery system 103. Theaiming beam 7402 is used to indicate the location of the emittedinvisible infrared beam 7404. The aiming beam 7402 may be activatedprior to the activation of the 7401 beam to assist the clinician inlocating and predicting the path of the 7401 beam when it is activatedto perform the clinical procedures.

OTHER EMBODIMENTS

According to other embodiments contemplated by the present disclosure,example embodiments may include a computer processor such as a singlecore or multi-core central processing unit (CPU) or micro-processingunit (MPU), which is constructed to realize the functionality describedabove. The computer processor might be incorporated in a stand-aloneapparatus or in a multi-component apparatus, or might comprise multiplecomputer processors which are constructed to work together to realizesuch functionality. The computer processor or processors execute acomputer-executable program (sometimes referred to ascomputer-executable instructions or computer-executable code) to performsome or all of the above-described functions. The computer-executableprogram may be pre-stored in the computer processor(s), or the computerprocessor(s) may be functionally connected for access to anon-transitory computer-readable storage medium on which thecomputer-executable program or program steps are stored. For thesepurposes, access to the non-transitory computer-readable storage mediummay be a local access such as by access via a local memory busstructure, or may be a remote access such as by access via a wired orwireless network or Internet. The computer processor(s) may thereafterbe operated to execute the computer-executable program or program stepsto perform functions of the above-described embodiments.

According to still further embodiments contemplated by the presentdisclosure, example embodiments may include methods in which thefunctionality described above is performed by a computer processor suchas a single core or multi-core central processing unit (CPU) ormicro-processing unit (MPU). As explained above, the computer processormight be incorporated in a stand-alone apparatus or in a multi-componentapparatus, or might comprise multiple computer processors which worktogether to perform such functionality. The computer processor orprocessors execute a computer-executable program (sometimes referred toas computer-executable instructions or computer-executable code) toperform some or all of the above-described functions. Thecomputer-executable program may be pre-stored in the computerprocessor(s), or the computer processor(s) may be functionally connectedfor access to a non-transitory computer-readable storage medium on whichthe computer-executable program or program steps are stored. Access tothe non-transitory computer-readable storage medium may form part of themethod of the embodiment. For these purposes, access to thenon-transitory computer-readable storage medium may be a local accesssuch as by access via a local memory bus structure, or may be a remoteaccess such as by access via a wired or wireless network or Internet.The computer processor(s) is/are thereafter operated to execute thecomputer-executable program or program steps to perform functions of theabove-described embodiments.

The non-transitory computer-readable storage medium on which acomputer-executable program or program steps are stored may be any of awide variety of tangible storage devices which are constructed toretrievably store data, including, for example, any of a flexible disk(floppy disk), a hard disk, an optical disk, a magneto-optical disk, acompact disc (CD), a digital versatile disc (DVD), micro-drive, aread-only memory (ROM), random-access memory (RAM), erasableprogrammable read-only memory (EPROM), electronically erasableprogrammable read-only memory (EEPROM), dynamic random-access memory(DRAM), video RAM (VRAM), a magnetic tape or card, optical card,nanosystem, molecular memory integrated circuit, redundant array ofindependent disks (RAID), a nonvolatile memory card, a flash memorydevice, a storage of distributed computing systems and the like. Thestorage medium may be a function expansion unit removably inserted inand/or remotely accessed by the apparatus or system for use with thecomputer processor(s).

This disclosure has provided a detailed description with respect toparticular representative embodiments. It is understood that the scopeof the appended claims is not limited to the above-described embodimentsand that various changes and modifications may be made without departingfrom the scope of the claims.

What is claimed is:
 1. A laser-assisted gingivitis and periodontitisbone, periodontal ligament and cementum tissue complex true regenerationprocedure using a free-running (FR) pulsed neodymium yttrium aluminumgarnet (Nd:YAG) laser device, the procedure comprising: anesthetizingsoft and hard tissues corresponding to a targeted tooth, quadrant orsextant of teeth of a patient, the tooth having a root and root surface;bone-sounding in a pocket around the targeted tooth and root using aperiodontal probe, and recording the depths of all bony defects in thesoft tissue around the tooth root and to bone, and into the bony defect,from an upper gingival margin to the extent of the accessible bonydefect; photothermally rupturing, disassociating, separating, ablating,denaturing and vaporizing the inner diseased, inflamed, infected,bacteria-invaded, or ulcerated epithelial lining of the pocket andgranulomatous tissues, reducing inflammation, or denaturing pathologicproteins, or photothermally altering, disrupting, denaturing,dehydrating or destroying calculus or concrements on the tooth and rootsurface, to the soft tissue or hard tissue extent of the pocket and fullbony defect, on the tooth or root to prepare an apical to coronal newconnective tissue surface, or to prepare the root surface of said toothfor a complete new true regenerative tissue complex consisting of newalveolar bone, periodontal ligament and cementum, or long junctionalepithelium; lasing the tooth and root surface to destroy or denaturelipopolysaccharides (LPS) of bacteria; debridement or removal from thetooth or root surface foreign matter, bacterial smear layer covering andincluded in soft and hard calcification, calculus, concrements, cementon the tooth or root surface to the depth of the pocket on the sides ofthe tooth or root surfaces from crestal margin to bony defect base;dissecting, releasing, cutting, breaking through any attachments betweenthe soft tissue and the root surface to create a surgical flap andaccess to the bony defect; performing at least one of reshaping,removing, resecting, transecting, troughing, modifying, manipulating,decorticating or perforating the bone to perform an osteotomy orostectomy, or to initiate angiogenesis; lasing to irradiate the bone atthe base of the bony defect to initiate hemostasis from the medullarybone, stimulate and upregulate the release of growth factors, andstimulate or upregulate fibroblasts or stem cells, warm the blood in thepocket to cleave fibrinogen, converting the blood into fibrin, create astable fibrin clot, and create angiogenesis; remove or denaturegranulomatous tissue and inflamed, infected and diseased epitheliallining, leaving granulation tissue in place inclusive of stem cells, orcapillaries, or fibroblasts, but disinfected, and disinfect, assist inhemostasis, cauterize free nerve endings, or seal lymphatics of thepocket tissue surface, and prepare the pocket tissue surface foradhesion; lasing the pocket tissue surface to adapt the pocket tissuesurface for tissue adhesion; maintaining the pocket tissue surface incontact with the tooth and root surface to advance adhesion; andeliminating occlusal interferences and occlusal traumatic forces.
 2. Themethod of claim 1, wherein the depth measuring is completed with aperiodontal probe taking measurements around the tooth root.
 3. Themethod of claim 1, wherein the step of ablating or vaporizing or thesteps of lasing are completed with a laser fiber oriented parallel tothe surface of the tooth root.
 4. The method of claim 1, wherein thestep of ablating or vaporizing is completed with not more than 6.00Watts of average output power from the FR Nd:YAG laser device, asmeasured at the distal end of the fiber, and while operating the FRNd:YAG laser device within the parameter range.
 5. The method of claim4, wherein the laser fiber is of a diameter between approximately 200and 600 microns.
 6. The method of claim 1, wherein said step ofmaintaining contact of the pocket tissue surface further comprisesapplication of firm pressure to hold the pocket tissue surface incontact with the tooth and root surface for 1 to 3 minutes allowing athin clot to form between the pocket tissue surface and the tooth orroot surface.
 7. The method of claim 1, wherein the optical fibercomprises an optical fiber, with diameter between 200 and 600 microns.8. The method of claim 7, wherein the optical fiber comprises a opticalfiber sized to fit through the handpiece.
 9. The method of claim 1,wherein the handpiece is a handpiece holding a bendable cannula.
 10. Themethod of claim 1, further including the step of prescribing medicationsfor outpatient use in preventing infection.
 11. The method of claim 1,further including the step of providing at least one subsequent occlusalequilibration examination.
 12. The method of claim 1, further comprisingthe step of enhancing the patient's natural immune system to protectagainst infection or reduce inflammation.
 13. The method of claim 1,wherein the laser device has a 1,064-nanometer wavelength and operatesover a parameter range which includes duty cycles between 0.10 and 1.95percent (100 to 650 microseconds at 10 to 30 hertz); average powersbetween 2.4 Watts and 6.0 Watts; energy levels between 80 millijoulesand 600 millijoules; peak powers between 123 Watts/pulse and 6000Watts/pulse; energy densities between 64 J/cm2 and 849 J/cm2; and powerdensities between 1910 Watts/cm2 and 8488 Watts/cm2.
 14. The method ofclaim 1, wherein the anesthetization is performed via a nerve block orby infiltration.
 15. The method of claim 1, wherein after said step ofbone-sounding in a pocket, and before said step of photothermallyrupturing, disassociating, separating, ablating, denaturing orvaporizing, the method further comprises: recording the sum total of theprobe depths/bone soundings and converting so as to obtain a total lightdose estimation in units of Joules to be delivered.
 16. The method ofclaim 15, wherein the conversion from probe depths/bone soundings to thetotal light dose estimation comprises multiplying by 1 to 40, dependingon soft tissue phenotype (biotype), a laser-assisted periodontalregeneration Periodontal Disease Case Type Classification I-V, and alaser-assisted periodontal regeneration Tooth Mobility Score 0-4. 17.The method of claim 15, wherein said step of ablating and vaporizingcomprises application of ⅔ of the total light dose using an opticalfiber, with dimeter between 200 and 600 microns, fed through a handpieceand a bendable cannula, while operating the FR Nd:YAG laser devicewithin the parameter range.
 18. The method of claim 17, wherein saidlasing steps comprise application of the remaining ⅓ of the total lightdose using an optical fiber, with diameter between 200 and 600 microns,fed through a handpiece and bendable cannula, while operating the FRNd:YAG laser device within the parameter range.
 19. The method of claim1, wherein said step of cleaning comprises application of apiezo-electric ultrasonic device with water lavage.
 20. The method ofclaim 19, wherein said step of cleaning comprises application of apiezo-electric ultrasonic device with water lavage and 20,000 to 30,000hertz and use of tips operating at 8 to 10 Watts.
 21. The method ofclaim 1, further comprising using a blue light device with wavelengthemission in the range of 400 to 520 nm, such as a diode laser,Ti:sapphire laser, argon ion laser, light-emitting diode,superluminescent diode, halogen, plasma-arc curing (PAC), or other lightsource with energy densities between, but not limited to, 1 and 2500J/cm2 and power densities between, but not limited to, 10 to 1200 mW/cm2to simultaneously, sequentially, or singularly irradiate the pockettissue surface in order to kill or inactivate bacteria, spores, fungi,viruses, and bacteriophages, or suppress biofilm formation.
 22. Themethod of claim 1, wherein the growth factors whose release isstimulated or upregulated include at least one of IGF-I, IGF-II,TGF-beta 1, TGF-beta 2 and BMP-2.
 23. The method of claim 1, whereinafter said step of performing at least one of reshaping, removing,resecting, transecting, troughing, modifying, manipulating,decorticating or perforating the bone, and before said step of lasing toirradiate the bone at the base of the bony defect, the method furthercomprises: irrigating the pocket with a bactericidal solution.
 24. Themethod of claim 1, wherein after said step of lasing the pocket tissuesurface to adapt the pocket tissue surface, and before said step ofmaintaining the pocket tissue surface in contact with the tooth and rootsurface, the method further comprises: approximating the pocket tissuesurface with the tooth and root surface.
 25. A laser-assisted gingivitisor complete periodontitis bone, periodontal ligament or cementum tissuecomplex true regeneration procedure using a free-running (FR) pulsedneodymium yttrium aluminum garnet (Nd:YAG) laser device with a1,064-nanometer wavelength and operating over a parameter range whichincludes duty cycles between 0.10 and 1.95 percent (100 to 650microseconds at 10 to 30 hertz); average powers between 2.4 Watts and6.0 Watts; energy levels between 80 millijoules and 600 millijoules;peak powers between 123 Watts/pulse and 6000 Watts/pulse; energydensities between 64 J/cm2 and 849 J/cm2; and power densities between1910 Watts/cm2 and 8488 Watts/cm2, the procedure comprising: a)anesthetizing soft and hard tissues via a nerve block or alternativelyby infiltration, corresponding to a targeted tooth, quadrant or sextantof teeth of a patient, the tooth having a root and root surface; b)bone-sounding in a pocket around the targeted tooth and root using aperiodontal probe, and recording the depths of the bony defects in thesoft tissue around the tooth root and to bone, and into the full bonydefect, from an upper gingival margin to the extent of the accessiblebony defect; c) recording the sum total of all probe depths/bonesoundings and multiplying by 1 to 40, depending on soft tissue phenotype(biotype), a laser-assisted periodontal regeneration Periodontal DiseaseCase Type Classification I-V, and a laser-assisted periodontalregeneration Tooth Mobility Score 0-4, so as to obtain a total lightdose estimation in units of Joules to be delivered; d) photothermallyrupturing, disassociating, separating, ablating, denaturing orvaporizing the epithelial lining of the pocket and granulomatoustissues, reducing inflammation, denaturing pathologic proteinsphotothermally altering, disrupting, denaturing, dehydrating ordestroying hard calcified calculus or concrements on the tooth and rootsurface, to the soft tissue or hard tissue extent of the pocket and fullbony defect, on the tooth and root to prepare a new connective tissuesurface, and to prepare the root surface of said tooth for a completenew tissue complex consisting of new alveolar bone, periodontal ligamentand cementum, or long junctional epithelium, wherein said step ofablating and vaporizing comprises application of ⅔ of the total lightdose using an optical fiber, with diameter between 200 and 600 microns,fed through a handpiece and a bendable cannula, while operating the FRNd:YAG laser device within the parameter range; e) lasing the tooth androot surface to destroy or denature lipopolysaccharides (LPS) ofgram-negative bacteria; f) debridement or removal from the tooth androot surface of foreign matter, bacterial smear layer covering andincluded in soft and hard calcification, calculus, concrements, cementon the tooth or root surface on the sides of the tooth or root surfacesfrom crestal margin to bony defect base, wherein said step of cleaningcomprises lasing or application of a piezo-electric ultrasonic devicewith water lavage; g) dissecting, releasing, cutting, breaking throughattachments between the soft tissue and the root surface to create asurgical flap or access to the bony defect wherein said step (g)comprises application of a piezo-electric ultrasonic device with waterlavage; h) performing at least one of reshaping, removing, resecting,transecting, troughing, modifying, manipulating, decorticating orperforating the bone to perform an osteotomy or ostectomy, or toinitiate angiogenesis, wherein said step (h) comprises application of atleast one of a piezo-electric ultrasonic device with use of specializedtips, a laser, or hand instrumentation; i) irrigating the pocket with abactericidal solution; j) lasing to irradiate the bone at the base ofthe bony defect in the pocket depth measurement locations to initiatehemostasis from the medullary bone, stimulate and upregulate the releaseof growth factors , or stimulate or upregulate fibroblasts or stemcells, warm the blood in the pocket to cleave fibrinogen therebyconverting the blood into fibrin, create a stable fibrin clot, or createangiogenesis; remove or denature any remaining granulomatous tissue orinflamed, infected or diseased epithelial lining, leaving granulationtissue in place inclusive of stem cells, capillaries, fibroblasts, butdisinfected, and disinfect, assist in hemostasis, cauterize free nerveendings, or seal lymphatics of the pocket tissue surface, or prepare thepocket tissue surface for adhesion; k) lasing the pocket tissue surfaceto adapt the pocket tissue surface for tissue adhesion; wherein saidsteps (j) and (k) of lasing comprise application of the remaining ⅓ ofthe total light dose using a quartz optical fiber fed with a diameterbetween 200 and 600 microns, through a handpiece and bendable cannula,while operating the FR Nd:YAG laser device within the parameter range;l) approximating the pocket tissue surface with the tooth or rootsurface; m) maintaining the pocket tissue surface in contact with thetooth or root surface to advance adhesion; and n) eliminating occlusalinterferences or occlusal traumatic forces.
 26. The method of claim 25,further comprising using a blue light device with wavelength emission inthe range of 400 to 520 nm, such as a diode laser, Ti:sapphire laser,argon ion laser, light-emitting diode, superluminescent diode, halogen,plasma-arc curing (PAC), or other light source with energy densitiesbetween, but not limited to, 1 and 2500 J/cm2 and power densitiesbetween, but not limited to, 10 to 1200 mW/cm2 to simultaneously,sequentially, or singularly irradiate the pocket tissue surface in orderto kill or inactivate bacteria, spores, fungi, viruses, andbacteriophages, or suppress biofilm formation.
 27. The method of claim25, wherein in said step (f), said step of cleaning comprisesapplication of a piezo-electric ultrasonic device with water lavage and20,000 to 30,000 hertz and use of tips operating at 8 to 10 Watts; andwherein said step (g) comprises application of a piezo-electricultrasonic device with water lavage and 20,000 to 30,000 hertz and useof tips operating at 8 to 10 Watts.
 28. The method of claim 25, whereinin said step (j), the growth factors whose release is stimulated orupregulated include at least one of IGF-I, IGF-II, TGF-beta 1, TGF-beta2 and BMP-2.